Healthcare Provider Details

I. General information

NPI: 1982896072
Provider Name (Legal Business Name): OAKRIDGE DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 THORNWOOD DR STE B
SAN JOSE CA
95123-1222
US

IV. Provider business mailing address

5450 THORNWOOD DR STE B
SAN JOSE CA
95123-1222
US

V. Phone/Fax

Practice location:
  • Phone: 408-360-0270
  • Fax: 408-360-0275
Mailing address:
  • Phone: 408-360-0270
  • Fax: 408-360-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number38560
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number38560
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN AMIR MASHHOON
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 408-360-0270