Provider Demographics
NPI:1497814826
Name:SHAYESTEH, MANIJEH (DDS)
Entity Type:Individual
Prefix:
First Name:MANIJEH
Middle Name:
Last Name:SHAYESTEH
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 1:425 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3920
Mailing Address - Country:US
Mailing Address - Phone:415-309-1564
Mailing Address - Fax:
Practice Address - Street 1:48 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1805
Practice Address - Country:US
Practice Address - Phone:408-283-1265
Practice Address - Fax:408-278-1187
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice