Provider Demographics
NPI:1477688828
Name:DEJBAKHSH, SHIREEN (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:SHIREEN
Middle Name:
Last Name:DEJBAKHSH
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 S BRISTOL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7300
Mailing Address - Country:US
Mailing Address - Phone:714-549-3341
Mailing Address - Fax:714-549-2876
Practice Address - Street 1:3620 S BRISTOL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7300
Practice Address - Country:US
Practice Address - Phone:714-549-3341
Practice Address - Fax:714-549-2876
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice