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General NPI Number Information
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NPI Number | 1689181745
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Entity Type | Organization
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Legal Business Name | SIAVASH DEHGHANI D.M.D. DENTAL CORP.
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 14465 S BASCOM AVE K
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-371-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 450 SUTTER ST 2500
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4206
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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 | PRESIDENT
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Name | DR. SIAVASH DEHGHANI
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Credential | DMD
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Telephone | 617-462-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 64099
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License Number State | CA
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