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General NPI Number Information
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NPI Number | 1043791890
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Entity Type | Organization
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Legal Business Name | A MOLA DDS APC
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 1050 NORTHGATE DR STE 505
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2542
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Country | US
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Telephone | 415-499-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 145 E 14TH ST # 100
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City | SAN LEANDRO
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State | CA
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Zip | 94577-1661
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Country | US
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Telephone | 510-587-9400
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ALIREZA MOLA
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Credential | GENERAL DENTIST DDS
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Telephone | 510-590-7297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 62246
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License Number State | CA
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