Provider Demographics
NPI:1497903264
Name:DR MAHMOUD H ASHRAFI D.M.D. M.S
Entity Type:Organization
Organization Name:DR MAHMOUD H ASHRAFI D.M.D. M.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ASHRAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, HS
Authorized Official - Phone:925-820-0303
Mailing Address - Street 1:1501 BOLLINGER CANYON ROAD, #B
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:925-820-0303
Mailing Address - Fax:925-820-7373
Practice Address - Street 1:1501 BOLLINGER CANYON ROAD, #B
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:925-820-0303
Practice Address - Fax:925-820-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA456391223G0001X
CA410581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty