Provider Demographics
NPI:1942861539
Name:LEYLI SHIRVANI DDS INC.
Entity Type:Organization
Organization Name:LEYLI SHIRVANI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEYLI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRVANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-858-7931
Mailing Address - Street 1:450 SUTTER ST RM 2130
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4112
Mailing Address - Country:US
Mailing Address - Phone:415-296-1126
Mailing Address - Fax:415-296-1128
Practice Address - Street 1:450 SUTTER ST RM 2130
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4112
Practice Address - Country:US
Practice Address - Phone:415-296-1126
Practice Address - Fax:415-296-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100296OtherDENTAL LICENSE