Provider Demographics
NPI:1598129405
Name:AHMADIAN, SHEEVA (DMD)
Entity Type:Individual
Prefix:
First Name:SHEEVA
Middle Name:
Last Name:AHMADIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5627 KANAN RD # 136
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-3358
Mailing Address - Country:US
Mailing Address - Phone:617-528-0044
Mailing Address - Fax:
Practice Address - Street 1:61 LONG CT
Practice Address - Street 2:SUITE #110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:617-528-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist