Healthcare Provider Details

I. General information

NPI: 1417658741
Provider Name (Legal Business Name): SAMANEH DAFTARIAN CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MIDDLEFIELD RD SUITE A
PALO ALTO CA
94306
US

IV. Provider business mailing address

3200 MIDDLEFIELD RD SUITE A
PALO ALTO CA
94306
US

V. Phone/Fax

Practice location:
  • Phone: 650-321-2012
  • Fax: 650-324-1908
Mailing address:
  • Phone: 650-321-2012
  • Fax: 650-324-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAMANEH DAFTARIAN
Title or Position: OWNER/DDS
Credential:
Phone: 650-885-0508