Healthcare Provider Details

I. General information

NPI: 1558281683
Provider Name (Legal Business Name): DANI JOUDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 ELMIRA RD STE 130
VACAVILLE CA
95687-4655
US

IV. Provider business mailing address

3130 OAK RD APT 216
WALNUT CREEK CA
94597-7753
US

V. Phone/Fax

Practice location:
  • Phone: 707-215-5259
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: