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General NPI Number Information
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NPI Number | 1326189028
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Entity Type | Organization
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Legal Business Name | ORALCARE ASSOCIATES
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2111 PARKSIDE DR SUITE B
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City | FREMONT
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State | CA
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Zip | 94536-5325
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Country | US
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Telephone | 510-797-9100
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Fax | 510-797-3429
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Provider Business Mailing Address
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Address Line | 2111 PARKSIDE DR SUITE B
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City | FREMONT
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State | CA
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Zip | 94536-5325
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Country | US
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Telephone | 510-797-9100
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Fax | 510-797-3429
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Authorized Official
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Title or Position | PARTNER OWNER
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Name | DR. TIMOTHY SAMUEL SHAHBAZIAN
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Credential | DDS
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Telephone | 510-797-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 38564
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 28087
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License Number State | CA
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