Provider Demographics
NPI:1164612446
Name:A. M. ASHTIANI, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:A. M. ASHTIANI, A PROFESSIONAL CORPORATION
Other - Org Name:NORTH BRIDGE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:A M
Authorized Official - Last Name:ASHTIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-789-9399
Mailing Address - Street 1:30 W EL ROSE DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-7525
Mailing Address - Country:US
Mailing Address - Phone:707-789-9399
Mailing Address - Fax:707-789-9199
Practice Address - Street 1:30 W EL ROSE DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-7525
Practice Address - Country:US
Practice Address - Phone:707-789-9399
Practice Address - Fax:707-789-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty