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General NPI Number Information
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NPI Number | 1992147409
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH DENTAL CARE
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 6201 ANTIOCH ST STE 102
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City | OAKLAND
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State | CA
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Zip | 94611-2945
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Country | US
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Telephone | 510-339-1544
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Fax |
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Provider Business Mailing Address
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Address Line | 6201 ANTIOCH ST SUITE 102
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City | OAKLAND
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State | CA
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Zip | 94611
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Country | US
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Telephone | 510-339-1544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEPAND HOKMABADI
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Credential | D.D.S
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Telephone | 41508301588
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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 | 50270
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License Number State | CA
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