Provider Demographics
NPI:1457771149
Name:KHOSHROOZEH, SARA (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:KHOSHROOZEH
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 1:20315 VENTURA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2449
Mailing Address - Country:US
Mailing Address - Phone:818-347-3535
Mailing Address - Fax:
Practice Address - Street 1:20315 VENTURA BLVD STE C
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2449
Practice Address - Country:US
Practice Address - Phone:818-347-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist