Healthcare Provider Details

I. General information

NPI: 1346410503
Provider Name (Legal Business Name): SKY DENTAL- SIAMAK JAFARI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 LOVERIDGE RD
PITTSBURG CA
94565-5019
US

IV. Provider business mailing address

2147 LOVERIDGE RD
PITTSBURG CA
94565-5019
US

V. Phone/Fax

Practice location:
  • Phone: 925-432-2444
  • Fax: 925-432-2008
Mailing address:
  • Phone: 925-432-2444
  • Fax: 925-432-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: SIAMAK JAFARI
Title or Position: OWNER
Credential: DMD
Phone: 925-432-2444