Provider Demographics
NPI:1407468457
Name:GERANNAZAR, SOMAYE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOMAYE
Middle Name:
Last Name:GERANNAZAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 S BIXEL ST APT A927
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-6237
Mailing Address - Country:US
Mailing Address - Phone:949-892-8886
Mailing Address - Fax:
Practice Address - Street 1:722 S BIXEL ST APT A927
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-6237
Practice Address - Country:US
Practice Address - Phone:949-892-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA105367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program