Provider Demographics
NPI:1427283670
Name:GHODSI, SHARAM (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARAM
Middle Name:
Last Name:GHODSI
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 1:4011 MEADOWS LN
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-3101
Mailing Address - Country:US
Mailing Address - Phone:702-259-5295
Mailing Address - Fax:
Practice Address - Street 1:4011 MEADOWS LN
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3101
Practice Address - Country:US
Practice Address - Phone:702-259-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist