Provider Demographics
NPI:1609149277
Name:ANOOSHEH, NIRVANA (DDS)
Entity type:Individual
Prefix:DR
First Name:NIRVANA
Middle Name:
Last Name:ANOOSHEH
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 1:1210 E ARQUES AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5421
Mailing Address - Country:US
Mailing Address - Phone:408-746-0379
Mailing Address - Fax:408-746-0302
Practice Address - Street 1:1210 E ARQUES AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5421
Practice Address - Country:US
Practice Address - Phone:408-746-0379
Practice Address - Fax:408-746-0302
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice