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General NPI Number Information
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NPI Number | 1861018160
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Entity Type | Organization
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Legal Business Name | DENTISTS ON WHEELS
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 2210 GLADSTONE DR
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City | PITTSBURG
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State | CA
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Zip | 94565-5101
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Country | US
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Telephone | 310-663-0756
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Fax |
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Provider Business Mailing Address
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Address Line | 3049 STONEGATE DR
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City | ALAMO
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State | CA
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Zip | 94507-1761
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Country | US
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Telephone | 310-663-0756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND FOUNDER
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Name | MS. SHABNAM FARZANEH
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Credential | NON-PROFIT PRESIDENT
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Telephone | 310-663-0756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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