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General NPI Number Information
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NPI Number | 1871034397
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Entity Type | Organization
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Legal Business Name | R K NASSIRI, DDS, MSD, INC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/16/2017
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Provider Practice Location Address
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Address Line | 3466 MT DIABLO BLVD SUITE C207
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City | LAFAYETTE
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State | CA
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Zip | 94549-7106
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Country | US
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Telephone | 925-298-5281
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Fax | 925-298-5419
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Provider Business Mailing Address
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Address Line | 3466 MT DIABLO BLVD SUITE C207
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City | LAFAYETTE
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State | CA
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Zip | 94549-7106
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Country | US
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Telephone | 925-298-5281
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Fax | 925-298-5419
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMTIN NASSIRI
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Credential | D.D.S., M.S.D.
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Telephone | 925-298-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 53997
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 55427
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 54020
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 54020
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License Number State | CA
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