Healthcare Provider Details

I. General information

NPI: 1801162987
Provider Name (Legal Business Name): MEHI M. VANDI DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S BASCOM AVE SUITE #100
CAMPBELL CA
95008-2364
US

IV. Provider business mailing address

1930 S BASCOM AVE SUITE #100
CAMPBELL CA
95008-2364
US

V. Phone/Fax

Practice location:
  • Phone: 408-963-6678
  • Fax: 408-963-6668
Mailing address:
  • Phone: 408-963-6678
  • Fax: 408-963-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40849
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH 19264
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH 25903
License Number StateCA

VIII. Authorized Official

Name: DR. MEHDI M VANDI
Title or Position: PRESIDENT
Credential: DDS
Phone: 408-963-6678