Provider Demographics
NPI:1770876435
Name:EZZATI, PARISA (DDS)
Entity type:Individual
Prefix:DR
First Name:PARISA
Middle Name:
Last Name:EZZATI
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 1:11029 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-5008
Mailing Address - Country:US
Mailing Address - Phone:818-368-5881
Mailing Address - Fax:818-368-5882
Practice Address - Street 1:11029 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5008
Practice Address - Country:US
Practice Address - Phone:818-368-5881
Practice Address - Fax:818-368-5882
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist