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General NPI Number Information
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NPI Number | 1154329084
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Entity Type | Organization
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Legal Business Name | SHIRIN SHAHINFAR IMANI DDS INC
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 675 MARINERS ISLAND BLVD SUITE 110
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City | SAN MATEO
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State | CA
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Zip | 94404-1062
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Country | US
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Telephone | 650-577-1988
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Fax | 650-577-0835
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Provider Business Mailing Address
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Address Line | 675 MARINERS ISLAND BLVD SUITE 110
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City | SAN MATEO
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State | CA
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Zip | 94404-1062
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Country | US
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Telephone | 650-577-1988
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Fax | 650-577-0835
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SHIRIN SHAHINFAR IMANI
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Credential | DDS
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Telephone | 650-577-1988
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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 | 42093
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License Number State | CA
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