Provider Demographics
NPI:1437301702
Name:SAMI-DOWLATSHAHI, SHAHRZAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRZAD
Middle Name:
Last Name:SAMI-DOWLATSHAHI
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 1:18030 RANCHO ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4213
Mailing Address - Country:US
Mailing Address - Phone:310-720-1070
Mailing Address - Fax:818-761-1761
Practice Address - Street 1:23-022 DEN BLDG BOX 951668
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-720-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2008-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA578371223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics