Healthcare Provider Details

I. General information

NPI: 1154309250
Provider Name (Legal Business Name): MEHRDAD AMANI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 110924
CAMPBELL CA
95011-0924
US

IV. Provider business mailing address

PO BOX 110924
CAMPBELL CA
95011-0924
US

V. Phone/Fax

Practice location:
  • Phone: 510-390-4927
  • Fax:
Mailing address:
  • Phone: 510-390-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48075
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number048487
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: