Provider Demographics
NPI:1588149470
Name:SHAYESTEH, AMIR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:SHAYESTEH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD STE 902
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2611
Mailing Address - Country:US
Mailing Address - Phone:818-660-1101
Mailing Address - Fax:818-660-1109
Practice Address - Street 1:16055 VENTURA BLVD STE 902
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2611
Practice Address - Country:US
Practice Address - Phone:818-660-1101
Practice Address - Fax:818-660-1109
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1033881223X0400X
DCDLT00000031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics