Provider Demographics
NPI:1629128897
Name:ASHTIANI, SHAHRAM SEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:SEAN
Last Name:ASHTIANI
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 1:23482 ALICIA PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2601
Mailing Address - Country:US
Mailing Address - Phone:614-266-1584
Mailing Address - Fax:
Practice Address - Street 1:23482 ALICIA PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2601
Practice Address - Country:US
Practice Address - Phone:614-266-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20907122300000X
CA54112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist