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General NPI Number Information
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NPI Number | 1053867622
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Entity Type | Organization
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Legal Business Name | FALLON DENTAL GROUP
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 3746 FALLON RD FALLON GATEWAY
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City | DUBLIN
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State | CA
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Zip | 94568
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Country | US
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Telephone | 925-803-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 4284 DIAVILA AVE
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City | PLEASANTON
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State | CA
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Zip | 94588-8373
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Country | US
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Telephone | 925-206-0735
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AZITA KABIRI
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Credential | DDS
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Telephone | 925-206-0735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DDS100543
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License Number State | CA
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