Provider Demographics
NPI:1720811615
Name:JAMSHIDI, LEILA MICHELLE (DDS)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:MICHELLE
Last Name:JAMSHIDI
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 1:1196 VALENCIA ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3027
Mailing Address - Country:US
Mailing Address - Phone:415-400-3854
Mailing Address - Fax:
Practice Address - Street 1:5925 BIRDCAGE CENTRE LN STE D105
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-8007
Practice Address - Country:US
Practice Address - Phone:916-246-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist