Provider Demographics
NPI:1518094291
Name:ALIREZA SHARIFZADEH DDS INC
Entity Type:Organization
Organization Name:ALIREZA SHARIFZADEH DDS INC
Other - Org Name:AL SHARIF DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARIFZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-488-1611
Mailing Address - Street 1:460 E PLEASANT VALLEY RD
Mailing Address - Street 2:#B
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041
Mailing Address - Country:US
Mailing Address - Phone:805-488-1611
Mailing Address - Fax:805-986-9406
Practice Address - Street 1:460 E PLEASANT VALLEY RD
Practice Address - Street 2:#B
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93041
Practice Address - Country:US
Practice Address - Phone:805-488-1611
Practice Address - Fax:805-986-9406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADJ0355501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B3555001Medicare UPIN