Provider Demographics
NPI:1386004232
Name:NEMOVI, SHAHRYAR (DDS)
Entity Type:Individual
Prefix:
First Name:SHAHRYAR
Middle Name:
Last Name:NEMOVI
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 1:767 NYES PL
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4140
Mailing Address - Country:US
Mailing Address - Phone:949-395-6004
Mailing Address - Fax:
Practice Address - Street 1:767 NYES PL
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-4140
Practice Address - Country:US
Practice Address - Phone:949-395-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist