Provider Demographics
NPI:1073541777
Name:AMIRI, HAMID (DDS)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:
Last Name:AMIRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3805
Mailing Address - Country:US
Mailing Address - Phone:707-318-0453
Mailing Address - Fax:
Practice Address - Street 1:8105 EDGEWATER DR
Practice Address - Street 2:SUITE 124
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2028
Practice Address - Country:US
Practice Address - Phone:510-552-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice