Provider Demographics
NPI:1629407135
Name:ETESSAMI, HIRI (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIRI
Middle Name:
Last Name:ETESSAMI
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 1:9201 W SUNSET BLVD STE 908
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3710
Mailing Address - Country:US
Mailing Address - Phone:310-550-0506
Mailing Address - Fax:310-550-0613
Practice Address - Street 1:9201 W SUNSET BLVD STE 908
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3710
Practice Address - Country:US
Practice Address - Phone:310-550-0506
Practice Address - Fax:310-550-0613
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics