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General NPI Number Information
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NPI Number | 1417543489
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Entity Type | Organization
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Legal Business Name | ABOLFAZLIAN DENTAL INC.
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Dates
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Enumeration Date | 12/14/2020
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Last Update Date | 12/14/2020
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Provider Practice Location Address
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Address Line | 218 N WIGET LN
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2404
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Country | US
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Telephone | 925-946-1951
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Fax | 925-946-1959
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Provider Business Mailing Address
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Address Line | 618 COBBLESTONE DR
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City | SAN RAMON
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State | CA
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Zip | 94583-5340
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Country | US
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Telephone | 805-305-2222
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT/ORTHODONTIST
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Name | DR. ARASH ABOLFAZLIAN
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Credential | DDS, MSD
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Telephone | 925-946-1951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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