Provider Demographics
NPI:1629260138
Name:SHAHRAM AMERIPOUR DDS INC.
Entity Type:Organization
Organization Name:SHAHRAM AMERIPOUR DDS INC.
Other - Org Name:SHAHRAM AMERIPOUR DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AMERIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-203-4272
Mailing Address - Street 1:3826 SEVEN TREES BLVD #300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111
Mailing Address - Country:US
Mailing Address - Phone:818-203-4272
Mailing Address - Fax:408-363-6464
Practice Address - Street 1:3826 SEVEN TREES BLVD #300
Practice Address - Street 2:#300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111
Practice Address - Country:US
Practice Address - Phone:408-363-6464
Practice Address - Fax:408-363-6463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAHRAM AMERIPOUR DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-17
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4083636464Other4083636464