Provider Demographics
NPI:1811559974
Name:HOSHIYAR, DIARY DANA (DDS)
Entity Type:Individual
Prefix:
First Name:DIARY
Middle Name:DANA
Last Name:HOSHIYAR
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 1:10870 SINCLARE CIR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6549
Mailing Address - Country:US
Mailing Address - Phone:407-408-1698
Mailing Address - Fax:
Practice Address - Street 1:1601 MONTE VISTA AVE STE 210
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6600
Practice Address - Country:US
Practice Address - Phone:909-554-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1036961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice