Healthcare Provider Details

I. General information

NPI: 1720462138
Provider Name (Legal Business Name): VAFI AHANI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SAN MATEO DR
SAN MATEO CA
94401-2761
US

IV. Provider business mailing address

150 N SAN MATEO DR
SAN MATEO CA
94401-2761
US

V. Phone/Fax

Practice location:
  • Phone: 650-524-4855
  • Fax: 650-524-4859
Mailing address:
  • Phone: 650-524-4855
  • Fax: 650-524-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42967
License Number StateCA

VIII. Authorized Official

Name: DR. HESSAM AHANI
Title or Position: CEO
Credential: DDS
Phone: 650-524-4855