Provider Demographics
NPI:1871845636
Name:SHAHBAZIAN, PIROUZ (DDS)
Entity Type:Individual
Prefix:
First Name:PIROUZ
Middle Name:
Last Name:SHAHBAZIAN
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 1:1616 E 4TH ST
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5160
Mailing Address - Country:US
Mailing Address - Phone:714-360-9474
Mailing Address - Fax:
Practice Address - Street 1:1616 E 4TH ST
Practice Address - Street 2:SUITE # 120
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5160
Practice Address - Country:US
Practice Address - Phone:714-360-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist