Provider Demographics
NPI:1689903346
Name:ESHAGHIAN, SIAMAK (DDS)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ESHAGHIAN
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 1:121 S PALM DR APT 505
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3537
Mailing Address - Country:US
Mailing Address - Phone:310-666-8978
Mailing Address - Fax:
Practice Address - Street 1:121 S PALM DR APT 505
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3537
Practice Address - Country:US
Practice Address - Phone:310-666-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59687122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist