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General NPI Number Information
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NPI Number | 1790200962
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Entity Type | Organization
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Legal Business Name | AZAR MAHMOUDI,DDS,CORP
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 2819 CROW CANYON RD STE 104
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City | SAN RAMON
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State | CA
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Zip | 94583-1656
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Country | US
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Telephone | 925-837-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 2819 CROW CANYON RD STE 104
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City | SAN RAMON
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State | CA
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Zip | 94583-1656
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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 | AZAR MAHMOUDI
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Credential |
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Telephone | 925-997-5957
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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 |
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License Number State |
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