Healthcare Provider Details

I. General information

NPI: 1275812356
Provider Name (Legal Business Name): SEYED AMIR M HOSSEINI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 GRANITE DR
ALAMO CA
94507-1604
US

IV. Provider business mailing address

2227 GRANITE DR
ALAMO CA
94507-1604
US

V. Phone/Fax

Practice location:
  • Phone: 925-918-2957
  • Fax:
Mailing address:
  • Phone: 925-918-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6118
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number64469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: