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General NPI Number Information
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NPI Number | 1659808624
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Entity Type | Organization
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Legal Business Name | KABIRI PREMIER DENTAL INC.
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 425 ESTUDILLO AVE STE B
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4906
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Country | US
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Telephone | 510-969-8510
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Fax | 510-878-2690
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Provider Business Mailing Address
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Address Line | 4284 DIAVILA AVE
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City | PLEASANTON
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State | CA
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Zip | 94588-8373
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Country | US
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Telephone | 925-206-0735
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Fax | 510-878-2690
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AZITA KABIRI
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Credential | D.D.S.
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Telephone | 925-206-0735
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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 | 100543
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License Number State | CA
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