Provider Demographics
NPI:1518040161
Name:PIROUZNIA, GEETA
Entity Type:Individual
Prefix:DR
First Name:GEETA
Middle Name:
Last Name:PIROUZNIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11629 DAWSON DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5128
Mailing Address - Country:US
Mailing Address - Phone:650-941-3149
Mailing Address - Fax:
Practice Address - Street 1:1061 EL MONTE AVE STE C
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2320
Practice Address - Country:US
Practice Address - Phone:650-968-5024
Practice Address - Fax:650-968-0423
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP2677663OtherDEA