Provider Demographics
NPI:1659422194
Name:SHIRAZI, DAVID ESMALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ESMALL
Last Name:SHIRAZI
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 1:558 SAINT CHARLES DR
Mailing Address - Street 2:201
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3903
Mailing Address - Country:US
Mailing Address - Phone:805-496-5700
Mailing Address - Fax:805-496-5719
Practice Address - Street 1:558 SAINT CHARLES DR
Practice Address - Street 2:201
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3903
Practice Address - Country:US
Practice Address - Phone:805-496-5700
Practice Address - Fax:805-496-5719
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48020122300000X
CAAC 11429171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No171100000XOther Service ProvidersAcupuncturist