Provider Demographics
NPI:1770199333
Name:SHAHSAVAR HAGHIGHI, MELIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELIKA
Middle Name:
Last Name:SHAHSAVAR HAGHIGHI
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 1:234 S FIGUEROA ST APT 1539
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2568
Mailing Address - Country:US
Mailing Address - Phone:310-962-5514
Mailing Address - Fax:
Practice Address - Street 1:13768 ROSWELL AVE # 110V
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-902-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist