Provider Demographics
NPI:1407341621
Name:AMIRI AND LUQUE DENTAL CORP
Entity Type:Organization
Organization Name:AMIRI AND LUQUE DENTAL CORP
Other - Org Name:OAKLAND DENTAL SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEMIEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-256-7116
Mailing Address - Street 1:8105 EDGEWATER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2019
Mailing Address - Country:US
Mailing Address - Phone:510-256-7116
Mailing Address - Fax:
Practice Address - Street 1:8105 EDGEWATER DR STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2019
Practice Address - Country:US
Practice Address - Phone:510-256-7116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0300X, 1223S0112X
CA617951223S0112X
CA102443261QD0000X
CA54003261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty