Provider Demographics
NPI:1982981957
Name:RAZI, MIRIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:RAZI
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 1:435 S CLARK DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3609
Mailing Address - Country:US
Mailing Address - Phone:310-488-2044
Mailing Address - Fax:
Practice Address - Street 1:435 S CLARK DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3609
Practice Address - Country:US
Practice Address - Phone:310-488-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60655122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist