Provider Demographics
NPI:1124178140
Name:ABBASZADEH, POURAN DOKHT (DDS)
Entity type:Individual
Prefix:DR
First Name:POURAN
Middle Name:DOKHT
Last Name:ABBASZADEH
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 1:27171 CALAROGA AVE
Mailing Address - Street 2:SUITE # 11
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4344
Mailing Address - Country:US
Mailing Address - Phone:510-264-2000
Mailing Address - Fax:510-264-2005
Practice Address - Street 1:27171 CALAROGA AVE
Practice Address - Street 2:SUITE # 11
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4344
Practice Address - Country:US
Practice Address - Phone:510-264-2000
Practice Address - Fax:510-264-2005
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice