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Provider Information for 1710049598



REZA J SHIRAZI DDS

Gender: MALE

Individual NPI: 1710049598

Calendar Last Updated: 2007-07-08

Details

Name Value
NPI 1710049598
Enumeration Date 2006-12-15
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2849 MUIR TRAIL DR
FULLERTON, CA 92833-5517
United States

Phone: 310-694-6156 | Fax:
View Map External Link
Primary Practice Address 81735 HIGHWAY 111, SUITE A
INDIO, CA 92201
United States

Phone: 760-391-4474 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CA 54475