Provider Demographics
NPI:1598899965
Name:AFSHAR, KIABOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIABOD
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4122
Mailing Address - Country:US
Mailing Address - Phone:760-745-2550
Mailing Address - Fax:760-746-7575
Practice Address - Street 1:327 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4122
Practice Address - Country:US
Practice Address - Phone:760-745-2550
Practice Address - Fax:760-746-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist