Provider Demographics
NPI:1972522209
Name:TAHERI, SHAHRAM (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:TAHERI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:--------
Other - Last Name:TAHERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:704 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-5403
Mailing Address - Country:US
Mailing Address - Phone:408-226-0323
Mailing Address - Fax:408-226-4418
Practice Address - Street 1:704 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5403
Practice Address - Country:US
Practice Address - Phone:408-226-0323
Practice Address - Fax:408-226-4418
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA437361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry