Provider Demographics
NPI:1366596439
Name:JAVIDZAD, FIROUZEH K MANESH (DDS)
Entity type:Individual
Prefix:DR
First Name:FIROUZEH
Middle Name:K MANESH
Last Name:JAVIDZAD
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 1:15720 VENTURA BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2922
Mailing Address - Country:US
Mailing Address - Phone:818-788-6684
Mailing Address - Fax:
Practice Address - Street 1:15720 VENTURA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2922
Practice Address - Country:US
Practice Address - Phone:818-788-6684
Practice Address - Fax:818-788-7890
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice