Provider Demographics
NPI:1366642670
Name:CYRUS M. AKHBARI D.M.D A PROFFESIONAL DENTAL COORPORATION
Entity Type:Organization
Organization Name:CYRUS M. AKHBARI D.M.D A PROFFESIONAL DENTAL COORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:AKHBARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-971-9990
Mailing Address - Street 1:1201 PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2919
Mailing Address - Country:US
Mailing Address - Phone:408-971-9990
Mailing Address - Fax:408-971-6628
Practice Address - Street 1:1201 PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-2919
Practice Address - Country:US
Practice Address - Phone:408-971-9990
Practice Address - Fax:408-971-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty