Provider Demographics
NPI:1174193791
Name:MOUSSAVIAN, PARISA AGHDAS
Entity Type:Individual
Prefix:DR
First Name:PARISA
Middle Name:AGHDAS
Last Name:MOUSSAVIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 HONEYGLEN CT
Mailing Address - Street 2:
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-2742
Mailing Address - Country:US
Mailing Address - Phone:805-660-9077
Mailing Address - Fax:
Practice Address - Street 1:6846 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-8509
Practice Address - Country:US
Practice Address - Phone:818-514-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1062921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice