Provider Demographics
NPI:1710446612
Name:NAMIRANIAN, POUYA (DMD)
Entity Type:Individual
Prefix:
First Name:POUYA
Middle Name:
Last Name:NAMIRANIAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MARBLE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7112
Mailing Address - Country:US
Mailing Address - Phone:408-410-1911
Mailing Address - Fax:
Practice Address - Street 1:8150 GREENBACK LN STE 300
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2505
Practice Address - Country:US
Practice Address - Phone:916-723-1111
Practice Address - Fax:916-723-1112
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1044231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty