Provider Demographics
NPI:1083223838
Name:SHARIFI, KAMYAR PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMYAR
Middle Name:PETER
Last Name:SHARIFI
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 1:3580 W GRANT LINE RD UNIT 422
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95304-9611
Mailing Address - Country:US
Mailing Address - Phone:408-781-0833
Mailing Address - Fax:
Practice Address - Street 1:1308 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-3029
Practice Address - Country:US
Practice Address - Phone:209-254-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist