Provider Demographics
NPI:1194885749
Name:HEIDARIAN, SHAHRZAD (DDS)
Entity type:Individual
Prefix:MRS
First Name:SHAHRZAD
Middle Name:
Last Name:HEIDARIAN
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 1:826 BRYANT STREET
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-327-1570
Mailing Address - Fax:650-330-1682
Practice Address - Street 1:826 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-327-1570
Practice Address - Fax:650-330-1682
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist