Healthcare Provider Details

I. General information

NPI: 1770316101
Provider Name (Legal Business Name): SHAYAN DADGAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 BLANDING AVE STE C122
ALAMEDA CA
94501-1579
US

IV. Provider business mailing address

2601 BLANDING AVE STE C122
ALAMEDA CA
94501-1579
US

V. Phone/Fax

Practice location:
  • Phone: 310-431-9414
  • Fax:
Mailing address:
  • Phone: 310-431-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110437
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: