Provider Demographics
NPI:1982436994
Name:SHARIATI, KEEMIA (DDS)
Entity type:Individual
Prefix:DR
First Name:KEEMIA
Middle Name:
Last Name:SHARIATI
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 1:1825 COUNTRYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1013
Mailing Address - Country:US
Mailing Address - Phone:925-818-9326
Mailing Address - Fax:
Practice Address - Street 1:806 SAN PABLO AVE STE 1
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2479
Practice Address - Country:US
Practice Address - Phone:510-974-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice