Provider Demographics
NPI:1891188512
Name:MAZLOOM, ARYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARYAN
Middle Name:
Last Name:MAZLOOM
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 1:5370 HOLLISTER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2396
Mailing Address - Country:US
Mailing Address - Phone:805-683-7777
Mailing Address - Fax:
Practice Address - Street 1:5370 HOLLISTER AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2396
Practice Address - Country:US
Practice Address - Phone:805-683-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist