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General NPI Number Information
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NPI Number | 1780190629
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Entity Type | Organization
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Legal Business Name | ANSARI DENTAL CORPORATION, INC.
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Dates
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Enumeration Date | 12/14/2017
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Last Update Date | 12/14/2017
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Provider Practice Location Address
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Address Line | 21310 SAN RAMON VALLEY BLVD. 2
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City | SAN RAMON
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State | CA
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Zip | 94583-4000
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Country | US
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Telephone | 925-828-0824
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Fax | 925-828-3426
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Provider Business Mailing Address
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Address Line | 21310 SAN RAMON VALLEY BLVD
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City | SAN RAMON
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State | CA
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Zip | 94583-4066
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Country | US
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Telephone | 925-828-0824
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Fax | 925-828-3426
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Authorized Official
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Title or Position | OWNER
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Name | MAHSA JABERIANSARI
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Credential | DDS
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Telephone | 925-828-0824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 59856
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License Number State | CA
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