Provider Demographics
NPI:1982219804
Name:KHOSHNIYATI, SARAH ANVARI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ANVARI
Last Name:KHOSHNIYATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:ANVARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50785 GRAND TRAVERSE AVE
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-5845
Mailing Address - Country:US
Mailing Address - Phone:949-302-3363
Mailing Address - Fax:
Practice Address - Street 1:44239 MONTEREY AVE
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2710
Practice Address - Country:US
Practice Address - Phone:760-568-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist