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General NPI Number Information
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NPI Number | 1720380710
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Entity Type | Individual
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Provider Name | REZA R SANJAR DMD
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Gender | Male
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 581 FOSTER CITY BLVD
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City | FOSTER CITY
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State | CA
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Zip | 94404-1695
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Country | US
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Telephone | 650-286-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 GULL AVE
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City | FOSTER CITY
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State | CA
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Zip | 94404-1445
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Country | US
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Telephone | 713-397-4320
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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 | 26058
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 100788
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License Number State | CA
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