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General NPI Number Information
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NPI Number | 1609285691
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Entity Type | Individual
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Provider Name | AMIR DADGAR-YEGANEH DDS
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Gender | Male
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 3030 ALUM ROCK AVE
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City | SAN JOSE
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State | CA
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Zip | 95127-2807
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Country | US
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Telephone | 310-774-1372
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 NORIEGA ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94122-4514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62830
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 62830
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License Number State | CA
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