MEDICARE: RAMTIN K NASSIRI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DDS54020	CA

General Provider Information

NPI Number	:	1124121231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMTIN K NASSIRI DDS

Provider Business Mailing Address
First Line	:	1183 SOLANO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1637
Country	:	US
Telephone Number	:	510-280-5731
Fax Number	:	510-280-5739

Provider Business Practice Location Address
First Line	:	1183 SOLANO AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1637
Country	:	US
Telephone Number	:	510-280-5731
Fax Number	:	510-280-5739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/09/2012

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