Provider Demographics
NPI:1508256173
Name:FIROOZ, RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:FIROOZ
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 1:17847 CHATSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5612
Mailing Address - Country:US
Mailing Address - Phone:818-832-3333
Mailing Address - Fax:818-832-3334
Practice Address - Street 1:17847 CHATSWORTH ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5612
Practice Address - Country:US
Practice Address - Phone:818-832-3333
Practice Address - Fax:818-832-3334
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS376611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice