Provider Demographics
NPI:1417262999
Name:REZAIE, SANAZ R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:R
Last Name:REZAIE
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 1:4691 LUNA CT
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3548
Mailing Address - Country:US
Mailing Address - Phone:818-667-6297
Mailing Address - Fax:
Practice Address - Street 1:4691 LUNA CT
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3548
Practice Address - Country:US
Practice Address - Phone:818-667-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice