Healthcare Provider Details

I. General information

NPI: 1770864415
Provider Name (Legal Business Name): SAHAR DADVAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 CLIPPER ST
SAN FRANCISCO CA
94114-3604
US

IV. Provider business mailing address

591 CLIPPER ST
SAN FRANCISCO CA
94114-3604
US

V. Phone/Fax

Practice location:
  • Phone: 415-793-9002
  • Fax:
Mailing address:
  • Phone: 415-793-9002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number60859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: