Provider Demographics
NPI:1497710248
Name:GHIASSI, GOLIRZ (DDS)
Entity Type:Individual
Prefix:
First Name:GOLIRZ
Middle Name:
Last Name:GHIASSI
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 1:712 D ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3709
Mailing Address - Country:US
Mailing Address - Phone:415-454-1267
Mailing Address - Fax:415-339-8336
Practice Address - Street 1:712 D ST
Practice Address - Street 2:SUITE I
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3709
Practice Address - Country:US
Practice Address - Phone:415-454-1267
Practice Address - Fax:415-339-8336
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice