Provider Demographics
NPI:1467572693
Name:KASHIRAD, KAMRAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:KASHIRAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RANCHO SQ
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-1672
Mailing Address - Country:US
Mailing Address - Phone:707-554-2200
Mailing Address - Fax:707-554-2211
Practice Address - Street 1:25 RANCHO SQ
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1672
Practice Address - Country:US
Practice Address - Phone:707-554-2200
Practice Address - Fax:707-554-2211
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist