Provider Demographics
NPI:1407183205
Name:MOLAYEM, SHERVIN M (DDS)
Entity type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:M
Last Name:MOLAYEM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 S LA CIENEGA BLVD # 943
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3302
Mailing Address - Country:US
Mailing Address - Phone:310-422-3851
Mailing Address - Fax:
Practice Address - Street 1:264 S LA CIENEGA BLVD # 943
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3302
Practice Address - Country:US
Practice Address - Phone:310-422-3851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589681223P0300X
NV61531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics