Provider Demographics
NPI:1518078682
Name:POURGHASSEMI, ANGELA F (DMD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:F
Last Name:POURGHASSEMI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 CAMINO RAMON
Mailing Address - Street 2:#230
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-790-0101
Mailing Address - Fax:925-790-0103
Practice Address - Street 1:2305 CAMINO RAMON
Practice Address - Street 2:#230
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-790-0101
Practice Address - Fax:925-790-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice