Provider Demographics
NPI:1669792388
Name:AGHABAK LAVASANI, SANAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:SANAZ
Middle Name:
Last Name:AGHABAK LAVASANI
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 1:10311 S DE ANZA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3028
Mailing Address - Country:US
Mailing Address - Phone:651-735-0595
Mailing Address - Fax:
Practice Address - Street 1:10311 S DE ANZA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3028
Practice Address - Country:US
Practice Address - Phone:408-886-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist