Provider Demographics
NPI:1346410503
Name:SKY DENTAL- SIAMAK JAFARI DENTAL CORPORATION
Entity Type:Organization
Organization Name:SKY DENTAL- SIAMAK JAFARI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-432-2444
Mailing Address - Street 1:2147 LOVERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5019
Mailing Address - Country:US
Mailing Address - Phone:925-432-2444
Mailing Address - Fax:925-432-2008
Practice Address - Street 1:2147 LOVERIDGE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5019
Practice Address - Country:US
Practice Address - Phone:925-432-2444
Practice Address - Fax:925-432-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty