Provider Demographics
NPI:1902419468
Name:YAZDANMEHR, SHAWYAN (DDS)
Entity type:Individual
Prefix:
First Name:SHAWYAN
Middle Name:
Last Name:YAZDANMEHR
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 1:3330 3RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-285-0950
Mailing Address - Fax:
Practice Address - Street 1:3330 3RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-285-0950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS110224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist