Provider Demographics
NPI:1194935684
Name:HESAM SHAHOVESIS DMD,INC
Entity type:Organization
Organization Name:HESAM SHAHOVESIS DMD,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HESAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHOVEISI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-334-4808
Mailing Address - Street 1:8716 CORD AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5507
Mailing Address - Country:US
Mailing Address - Phone:714-542-2224
Mailing Address - Fax:
Practice Address - Street 1:8716 CORD AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5507
Practice Address - Country:US
Practice Address - Phone:714-542-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty