Provider Demographics
NPI:1669658183
Name:ZAND, POOLAK AFSHAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:POOLAK
Middle Name:AFSHAR
Last Name:ZAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:POOLAK
Other - Middle Name:
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:212 E PROVIDENCIA AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1432
Mailing Address - Country:US
Mailing Address - Phone:818-845-7611
Mailing Address - Fax:
Practice Address - Street 1:19701 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2623
Practice Address - Country:US
Practice Address - Phone:818-758-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist