MEDICARE: BEHNAM ROSTAMI

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	122300000X	Dentist	49653	CA

General Provider Information

NPI Number	:	1639510563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEHNAM ROSTAMI

Provider Business Mailing Address
First Line	:	479 STONY POINT RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5969
Country	:	US
Telephone Number	:	707-523-3700
Fax Number	:	707-581-2032

Provider Business Practice Location Address
First Line	:	479 STONY POINT RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5969
Country	:	US
Telephone Number	:	707-523-3700
Fax Number	:	707-581-2032

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

Provider Enumeration Date	:	07/08/2013
Last Update Date	:	07/08/2013

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Directions to “ BEHNAM ROSTAMI ” Practice Location

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