Provider Demographics
NPI:1558429001
Name:BANDANI, ABDOLHOSSEIN (DDS)
Entity Type:Individual
Prefix:
First Name:ABDOLHOSSEIN
Middle Name:
Last Name:BANDANI
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 1:3838 WATT AVE
Mailing Address - Street 2:SUITE A100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-2663
Mailing Address - Country:US
Mailing Address - Phone:916-482-8082
Mailing Address - Fax:
Practice Address - Street 1:3838 WATT AVE
Practice Address - Street 2:SUITE A100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2663
Practice Address - Country:US
Practice Address - Phone:916-482-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist