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General NPI Number Information
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NPI Number | 1811363294
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Entity Type | Organization
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Legal Business Name | MAHSA JABERIANSARI DDS INC
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 2089 VALE RD SUITE 15 AND 16
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City | SAN PABLO
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State | CA
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Zip | 94806-3847
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Country | US
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Telephone | 415-746-9412
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Fax |
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Provider Business Mailing Address
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Address Line | 1 KENNETH DR
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City | MORAGA
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State | CA
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Zip | 94556-1600
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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 | CEO
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Name | DR. MAHSA JABERIANSARI
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Credential | DDS
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Telephone | 415-730-7162
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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 | 59856
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License Number State | CA
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