Provider Demographics
NPI:1609493170
Name:AMIR HAGHSHENAS DDS
Entity Type:Organization
Organization Name:AMIR HAGHSHENAS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHSHENAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-377-5134
Mailing Address - Street 1:3880 S BASCOM AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2675
Mailing Address - Country:US
Mailing Address - Phone:408-377-5134
Mailing Address - Fax:408-371-1675
Practice Address - Street 1:3880 S BASCOM AVE STE 213
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2675
Practice Address - Country:US
Practice Address - Phone:408-377-5134
Practice Address - Fax:408-371-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty