Provider Demographics
NPI:1558038158
Name:PARSAEE, MARYAM MICHELLE
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:MICHELLE
Last Name:PARSAEE
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 1:309 S DOHENY DR APT 2
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3521
Mailing Address - Country:US
Mailing Address - Phone:310-804-3906
Mailing Address - Fax:
Practice Address - Street 1:176 AUBURN CT STE 5
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3682
Practice Address - Country:US
Practice Address - Phone:805-496-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist