Healthcare Provider Details

I. General information

NPI: 1376828244
Provider Name (Legal Business Name): RAMTIN NASSIRI, DDS, MSD, A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
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:
Mailing address:
  • Phone: 510-280-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number54020
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number54020
License Number StateCA

VIII. Authorized Official

Name: DR. RAMTIN K. NASSIRI
Title or Position: DOCTOR/PRESIDENT
Credential: D.D.S., M.S.D.
Phone: 510-280-5731