Healthcare Provider Details

I. General information

NPI: 1023237716
Provider Name (Legal Business Name): AHANI AND VAFI DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALMETTO AVE STE F
PACIFICA CA
94044-2273
US

IV. Provider business mailing address

1301 PALMETTO AVE STE F
PACIFICA CA
94044-2273
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-2100
  • Fax: 650-738-9680
Mailing address:
  • Phone: 650-738-2100
  • Fax: 650-738-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. HESSAM AHANI
Title or Position: PRESIDENT
Credential: DDS
Phone: 650-738-2100