Provider Demographics
NPI:1245397975
Name:MAZDEYASNAN, AFSHIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:MAZDEYASNAN
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 1:2040 GLENOAKS BLVD
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340
Mailing Address - Country:US
Mailing Address - Phone:818-361-3889
Mailing Address - Fax:818-361-6280
Practice Address - Street 1:2040 GLENOAKS BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340
Practice Address - Country:US
Practice Address - Phone:818-361-3889
Practice Address - Fax:818-361-6280
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics