Provider Demographics
NPI:1942199765
Name:SHAHRAM VAZIRI DDS INC.
Entity type:Organization
Organization Name:SHAHRAM VAZIRI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-717-1661
Mailing Address - Street 1:11404 OLD GEORGETOWN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2892
Mailing Address - Country:US
Mailing Address - Phone:301-244-0024
Mailing Address - Fax:
Practice Address - Street 1:11404 OLD GEORGETOWN RD STE 206
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2892
Practice Address - Country:US
Practice Address - Phone:301-244-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental