Provider Demographics
NPI:1265838338
Name:SHIRAZI, SARA
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:SHIRAZI
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 1:5262 ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1819
Mailing Address - Country:US
Mailing Address - Phone:310-592-5318
Mailing Address - Fax:
Practice Address - Street 1:5262 ELVIRA RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1819
Practice Address - Country:US
Practice Address - Phone:310-592-5318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist