Individual
DR. SHERVIN GHOLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.M.SC.
Contact information
Practice address
620 CALIFORNIA BLVD, SUITE G, SAN LUIS OBISPO, CA 93401-2541
(805) 543-7668
(805) 543-7661
Mailing address
620 CALIFORNIA BLVD, SUITE G, SAN LUIS OBISPO, CA 93401-2541
(805) 543-7668
(805) 543-7661
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
48603
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-1089233
TAX IDENTIFICATION NUMBER
CA
Enumeration date
06/26/2007
Last updated
12/29/2009
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