Provider Demographics
NPI:1689252835
Name:GREENLAND, PARISA TAMASEBI (OMT)
Entity Type:Individual
Prefix:
First Name:PARISA
Middle Name:TAMASEBI
Last Name:GREENLAND
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4201
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-4201
Mailing Address - Country:US
Mailing Address - Phone:760-310-4069
Mailing Address - Fax:
Practice Address - Street 1:234 DIAMANTE WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3763
Practice Address - Country:US
Practice Address - Phone:176-031-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CARDH25321124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No174400000XOther Service ProvidersSpecialist