Provider Demographics
NPI:1235272287
Name:ASSILI DAMAVANDI, RAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:
Last Name:ASSILI DAMAVANDI
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 1:9535 RESEDA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-6027
Mailing Address - Country:US
Mailing Address - Phone:818-349-6373
Mailing Address - Fax:818-349-7539
Practice Address - Street 1:9535 RESEDA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-6027
Practice Address - Country:US
Practice Address - Phone:818-349-6373
Practice Address - Fax:818-349-7539
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist