Provider Demographics
NPI:1053178434
Name:AYVAZIAN-MESERKHANI, SAREEN PATEEL (DDS)
Entity type:Individual
Prefix:DR
First Name:SAREEN
Middle Name:PATEEL
Last Name:AYVAZIAN-MESERKHANI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAREEN
Other - Middle Name:PATEEL
Other - Last Name:AYVAZIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3232 BEAUDRY TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1747
Mailing Address - Country:US
Mailing Address - Phone:818-618-4146
Mailing Address - Fax:
Practice Address - Street 1:3232 BEAUDRY TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1747
Practice Address - Country:US
Practice Address - Phone:818-618-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics