Provider Demographics
NPI:1972816031
Name:REZVANI, SAHAR (DDS)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:REZVANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-2314
Mailing Address - Country:US
Mailing Address - Phone:818-439-4044
Mailing Address - Fax:
Practice Address - Street 1:9801 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1997
Practice Address - Country:US
Practice Address - Phone:818-886-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025804122300000X
CA61205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist