Provider Demographics
NPI:1508045790
Name:TMJ AND SLEEP THERAPY CENTRE OF CONEJO VALLEY
Entity Type:Organization
Organization Name:TMJ AND SLEEP THERAPY CENTRE OF CONEJO VALLEY
Other - Org Name:DAVID ESMAIL SHIRAZI, DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ESMAIL
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-496-5700
Mailing Address - Street 1:558 SAINT CHARLES DR # 201
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3903
Mailing Address - Country:US
Mailing Address - Phone:805-496-5700
Mailing Address - Fax:805-496-5719
Practice Address - Street 1:558 SAINT CHARLES DR # 201
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3903
Practice Address - Country:US
Practice Address - Phone:805-496-5700
Practice Address - Fax:805-496-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS48020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADDS48020OtherDENTAL BOARD OF CA
CAAC11429OtherACUPUNCTURE BOARD