Provider Demographics
NPI:1093156242
Name:REZA K. ARYANPOUR DDS, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:REZA K. ARYANPOUR DDS, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ARYANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-819-1977
Mailing Address - Street 1:1436 PROFESSIONAL DRIVE SUITE 302
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:415-819-1977
Mailing Address - Fax:
Practice Address - Street 1:1436 PROFESSIONAL DR STE 302
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6697
Practice Address - Country:US
Practice Address - Phone:415-819-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA476851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty