Provider Demographics
NPI:1619373685
Name:GOLRIZ, GELAYOL (DDS)
Entity Type:Individual
Prefix:DR
First Name:GELAYOL
Middle Name:
Last Name:GOLRIZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 DEL MORENO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4640
Mailing Address - Country:US
Mailing Address - Phone:818-802-6234
Mailing Address - Fax:
Practice Address - Street 1:4616 DEL MORENO DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4640
Practice Address - Country:US
Practice Address - Phone:818-802-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist