MEDICARE: DR. MAMAK SAFFARPOUR D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	49657	CA

General Provider Information

NPI Number	:	1740218312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAMAK SAFFARPOUR D.D.S

Provider Business Mailing Address
First Line	:	3535 ROSS AVE STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3038
Country	:	US
Telephone Number	:	408-269-2944
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 ROSS AVE STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3038
Country	:	US
Telephone Number	:	408-269-2944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	10/16/2015

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