Provider Demographics
NPI:1114474392
Name:YASAMAN SANI DDS INC.
Entity Type:Organization
Organization Name:YASAMAN SANI DDS INC.
Other - Org Name:CONCORD DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YASMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-588-4294
Mailing Address - Street 1:4125 CONCORD BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519
Mailing Address - Country:US
Mailing Address - Phone:925-849-4469
Mailing Address - Fax:925-849-4697
Practice Address - Street 1:4125 CONCORD BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-849-4469
Practice Address - Fax:925-849-4697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty