Provider Demographics
NPI:1912255860
Name:RAZAVI, TARANEH (DDS)
Entity Type:Individual
Prefix:
First Name:TARANEH
Middle Name:
Last Name:RAZAVI
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 1:17072 ESCALON DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3838
Mailing Address - Country:US
Mailing Address - Phone:310-871-1571
Mailing Address - Fax:
Practice Address - Street 1:8719 WOODLEY AVE STE B
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-4729
Practice Address - Country:US
Practice Address - Phone:818-830-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61843122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist