Provider Demographics
NPI:1841485877
Name:SHAHSAVARI, KAMRAN (DDS)
Entity type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:SHAHSAVARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1936 E DEERE AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5732
Mailing Address - Country:US
Mailing Address - Phone:949-567-3116
Mailing Address - Fax:866-666-9677
Practice Address - Street 1:1936 E DEERE AVE STE 130
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5732
Practice Address - Country:US
Practice Address - Phone:949-567-3116
Practice Address - Fax:866-666-9677
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice