Healthcare Provider Details

I. General information

NPI: 1124121231
Provider Name (Legal Business Name): RAMTIN K NASSIRI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1183 SOLANO AVE
ALBANY CA
94706-1637
US

IV. Provider business mailing address

1183 SOLANO AVE
ALBANY CA
94706-1637
US

V. Phone/Fax

Practice location:
  • Phone: 510-280-5731
  • Fax: 510-280-5739
Mailing address:
  • Phone: 510-280-5731
  • Fax: 510-280-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDDS54020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: