Provider Demographics
NPI:1326893355
Name:DR. RON HASSANZADEH, PC
Entity Type:Organization
Organization Name:DR. RON HASSANZADEH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-308-1440
Mailing Address - Street 1:2355 SAN RAMON VALLEY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1597
Mailing Address - Country:US
Mailing Address - Phone:925-458-7811
Mailing Address - Fax:
Practice Address - Street 1:2355 SAN RAMON VALLEY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1597
Practice Address - Country:US
Practice Address - Phone:925-458-7811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty