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General NPI Number Information
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NPI Number | 1174078539
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Entity Type | Organization
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Legal Business Name | LAVASANI & ESLAMI DENTAL GROUP INC
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Dates
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Enumeration Date | 08/16/2016
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 10311 S DE ANZA BLVD STE 6
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City | CUPERTINO
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State | CA
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Zip | 95014-3028
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Country | US
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Telephone | 408-807-1258
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Fax | 408-807-1688
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Provider Business Mailing Address
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Address Line | 10311 S DE ANZA BLVD STE 6
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City | CUPERTINO
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State | CA
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Zip | 95014-3028
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Country | US
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Telephone | 408-807-1258
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Fax | 408-807-1688
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YASHAR ESLAMI
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Credential | DDS
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Telephone | 408-807-1258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 64490
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License Number State | CA
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