Provider Demographics
NPI:1437849858
Name:REZA SHIRAZI DDS INC
Entity Type:Organization
Organization Name:REZA SHIRAZI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-694-6156
Mailing Address - Street 1:12052 HESPERIA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1808
Mailing Address - Country:US
Mailing Address - Phone:310-694-6156
Mailing Address - Fax:
Practice Address - Street 1:12052 HESPERIA RD STE 4
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1808
Practice Address - Country:US
Practice Address - Phone:310-694-6156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty