Provider Demographics
NPI:1851492029
Name:BONYANPOOR, SHAHNAZ (DDS)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:BONYANPOOR
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 1:62 CORPORATE PARK
Mailing Address - Street 2:SUITE 135
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-3122
Mailing Address - Country:US
Mailing Address - Phone:949-252-9950
Mailing Address - Fax:949-252-9959
Practice Address - Street 1:62 CORPORATE PARK
Practice Address - Street 2:SUITE 135
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-3122
Practice Address - Country:US
Practice Address - Phone:949-252-9950
Practice Address - Fax:949-252-9959
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9298501OtherDENTICAL