Provider Demographics
NPI:1508309014
Name:DJAFARI, PARISSA (DDS)
Entity Type:Individual
Prefix:
First Name:PARISSA
Middle Name:
Last Name:DJAFARI
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 1:6900 BROCKTON AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3819
Mailing Address - Country:US
Mailing Address - Phone:951-682-2245
Mailing Address - Fax:951-682-9169
Practice Address - Street 1:6900 BROCKTON AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3819
Practice Address - Country:US
Practice Address - Phone:951-682-2245
Practice Address - Fax:951-682-9169
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist