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General NPI Number Information
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NPI Number | 1083250468
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Entity Type | Organization
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Legal Business Name | MAHSA ESFANDIARI, D.D.S., DENTAL CORP.
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 14465 S BASCOM AVE STE K
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City | LOS GATOS
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State | CA
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Zip | 95032-2002
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Country | US
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Telephone | 408-477-0674
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 MOROCCO DR
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City | SAN JOSE
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State | CA
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Zip | 95125-5823
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Country | US
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Telephone | 408-477-0674
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MAHSA ESFANDIARI
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Credential | DDS
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Telephone | 408-477-0674
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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 |
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License Number State |
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