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General NPI Number Information
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NPI Number | 1700225752
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Entity Type | Individual
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Provider Name | MEHRAN HASSANZADEH D.M.D
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Gender | Male
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 10/05/2024
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Provider Practice Location Address
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Address Line | 2355 SAN RAMON VALLEY BLVD STE 105
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City | SAN RAMON
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State | CA
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Zip | 94583-1597
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Country | US
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Telephone | 925-452-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 SAN RAMON VALLEY BLVD # 4164
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City | SAN RAMON
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State | CA
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Zip | 94583-5381
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Country | US
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Telephone | 925-452-7811
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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 | DN014612
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License Number State | GA
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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 | DN014612
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107259
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License Number State | CA
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