Provider Demographics
NPI:1174760185
Name:BARADARAN, SHAHRIYAR E (DDS MS)
Entity type:Individual
Prefix:
First Name:SHAHRIYAR
Middle Name:E
Last Name:BARADARAN
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S. SPALDING DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1840
Mailing Address - Country:US
Mailing Address - Phone:310-903-7674
Mailing Address - Fax:
Practice Address - Street 1:120 S. SPALDING DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1840
Practice Address - Country:US
Practice Address - Phone:310-903-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics