Provider Demographics
NPI:1346433661
Name:SHOHREH NAFISI DDS INC
Entity Type:Organization
Organization Name:SHOHREH NAFISI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOHREH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAFIJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-830-0300
Mailing Address - Street 1:15239 ROSCOE BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4401
Mailing Address - Country:US
Mailing Address - Phone:818-830-0300
Mailing Address - Fax:818-920-5278
Practice Address - Street 1:15239 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4401
Practice Address - Country:US
Practice Address - Phone:818-830-0300
Practice Address - Fax:818-920-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA156591891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty