Provider Demographics
NPI:1477177616
Name:AMIR HOSSEINI DENTAL CORPORATION
Entity Type:Organization
Organization Name:AMIR HOSSEINI DENTAL CORPORATION
Other - Org Name:PETALUMA BRACES AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEYED AMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-787-5600
Mailing Address - Street 1:26 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3477
Mailing Address - Country:US
Mailing Address - Phone:707-787-5600
Mailing Address - Fax:
Practice Address - Street 1:26 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3477
Practice Address - Country:US
Practice Address - Phone:707-787-5600
Practice Address - Fax:707-787-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty