Provider Demographics
NPI:1932382066
Name:ROSTAMIAN, SHAHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHEN
Middle Name:
Last Name:ROSTAMIAN
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 1:22554 VENTURA BL # 135
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-224-4224
Mailing Address - Fax:818-224-4442
Practice Address - Street 1:22554 VENTURA BL # 135
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-224-4224
Practice Address - Fax:818-224-4442
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist