Provider Demographics
NPI:1972540318
Name:GOLYAD, AFSHIN (DDS)
Entity Type:Individual
Prefix:MR
First Name:AFSHIN
Middle Name:
Last Name:GOLYAD
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 1:12340 SANTA MONICA BLVD
Mailing Address - Street 2:#241
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-820-7010
Mailing Address - Fax:310-820-7060
Practice Address - Street 1:12340 SANTA MONICA BLVD
Practice Address - Street 2:#241
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-820-7010
Practice Address - Fax:310-820-7060
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice