Provider Demographics
NPI:1952656605
Name:YAZDANSHENAS, DESIREE (MS, DDS)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:YAZDANSHENAS
Suffix:
Gender:F
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY STE 350
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3172
Mailing Address - Country:US
Mailing Address - Phone:949-412-0977
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 350
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3172
Practice Address - Country:US
Practice Address - Phone:310-421-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist