Provider Demographics
NPI:1275038317
Name:SHAHEN ROSTAMIAN DDS INC
Entity Type:Organization
Organization Name:SHAHEN ROSTAMIAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTAMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-224-4224
Mailing Address - Street 1:22554 VENTURA BLVD STE 135
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1434
Mailing Address - Country:US
Mailing Address - Phone:818-224-4224
Mailing Address - Fax:818-224-4442
Practice Address - Street 1:8120 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2941
Practice Address - Country:US
Practice Address - Phone:818-224-4224
Practice Address - Fax:818-224-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental