Provider Demographics
NPI:1659479137
Name:VAKILI, LALEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LALEH
Middle Name:
Last Name:VAKILI
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 1:1700 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3047
Mailing Address - Country:US
Mailing Address - Phone:650-372-9292
Mailing Address - Fax:650-372-9193
Practice Address - Street 1:1700 S EL CAMINO REAL
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3047
Practice Address - Country:US
Practice Address - Phone:650-372-9292
Practice Address - Fax:650-372-9193
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry