Provider Demographics
NPI:1447386644
Name:ARYANPOUR, REZA KASHANI (DDS)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:KASHANI
Last Name:ARYANPOUR
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 1:55 MISSION CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5372
Mailing Address - Country:US
Mailing Address - Phone:707-568-0480
Mailing Address - Fax:707-568-0447
Practice Address - Street 1:55 MISSION CIRCLE SUITE 103
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-3603
Practice Address - Country:US
Practice Address - Phone:707-568-0480
Practice Address - Fax:707-568-0447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice