Provider Demographics
NPI:1659895753
Name:KHOOSHAB, SAHAR (DDS)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:KHOOSHAB
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 1:815 COLLEGE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6261
Mailing Address - Country:US
Mailing Address - Phone:760-306-4466
Mailing Address - Fax:
Practice Address - Street 1:815 COLLEGE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-6261
Practice Address - Country:US
Practice Address - Phone:760-306-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1015441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice