Provider Demographics
NPI:1245339043
Name:LAVI, SHAHRAM ABRAHAM (DMD)
Entity type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:ABRAHAM
Last Name:LAVI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4341 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1710
Mailing Address - Country:US
Mailing Address - Phone:818-980-8472
Mailing Address - Fax:
Practice Address - Street 1:4341 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1710
Practice Address - Country:US
Practice Address - Phone:818-980-8472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist