Provider Demographics
NPI:1417543489
Name:ABOLFAZLIAN DENTAL INC.
Entity Type:Organization
Organization Name:ABOLFAZLIAN DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOLFAZLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:925-946-1951
Mailing Address - Street 1:618 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5340
Mailing Address - Country:US
Mailing Address - Phone:805-305-2222
Mailing Address - Fax:
Practice Address - Street 1:218 N WIGET LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2404
Practice Address - Country:US
Practice Address - Phone:925-946-1951
Practice Address - Fax:925-946-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty