Provider Demographics
NPI:1801937230
Name:POURSHIRAZI DENTAL CORPORATION
Entity type:Organization
Organization Name:POURSHIRAZI DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:POURSHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-691-5096
Mailing Address - Street 1:23771 WASHINGTON AVE # H-102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2265
Mailing Address - Country:US
Mailing Address - Phone:951-691-5096
Mailing Address - Fax:951-691-5097
Practice Address - Street 1:23771 WASHINGTON AVE # H-102
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2265
Practice Address - Country:US
Practice Address - Phone:951-691-5096
Practice Address - Fax:951-691-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty