Provider Demographics
NPI:1407977077
Name:MADADSHAHI, ARJOMAND AVI (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARJOMAND
Middle Name:AVI
Last Name:MADADSHAHI
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 1:15501 SAN FERNANDO MISSION BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1364
Mailing Address - Country:US
Mailing Address - Phone:818-365-8600
Mailing Address - Fax:818-898-9984
Practice Address - Street 1:15501 SAN FERNANDO MISSION BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1364
Practice Address - Country:US
Practice Address - Phone:818-365-8600
Practice Address - Fax:818-898-9984
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA419501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41950-01OtherMEDI-CAL