Provider Demographics
NPI:1992981054
Name:SHAMAIZADEH, AFSHIN (DDS)
Entity type:Individual
Prefix:DR
First Name:AFSHIN
Middle Name:
Last Name:SHAMAIZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:AFSHIN
Other - Middle Name:
Other - Last Name:SHAMAIZADEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10826 VENICE BLVD
Mailing Address - Street 2:#101
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-202-0033
Mailing Address - Fax:310-202-6586
Practice Address - Street 1:10826 VENICE BLVD
Practice Address - Street 2:#101
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-202-0033
Practice Address - Fax:310-202-6586
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58748122300000X
NY053520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist