Provider Demographics
NPI:1164646469
Name:SHIRVAN, ALLAHYAR J (DDS)
Entity Type:Individual
Prefix:
First Name:ALLAHYAR
Middle Name:J
Last Name:SHIRVAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 STRATFORD CIR STE C36
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5069
Mailing Address - Country:US
Mailing Address - Phone:209-473-1010
Mailing Address - Fax:209-473-3805
Practice Address - Street 1:5635 STRATFORD CIR STE C36
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5069
Practice Address - Country:US
Practice Address - Phone:209-473-1010
Practice Address - Fax:209-473-3805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice