Provider Demographics
NPI:1679012009
Name:SEYED AMIR M HOSSEINI DDS INC
Entity Type:Organization
Organization Name:SEYED AMIR M HOSSEINI DDS INC
Other - Org Name:SAN LEANDRO BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST, ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED AMIR
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-568-3322
Mailing Address - Street 1:332 DUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2806
Mailing Address - Country:US
Mailing Address - Phone:510-568-3322
Mailing Address - Fax:510-568-7308
Practice Address - Street 1:332 DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2806
Practice Address - Country:US
Practice Address - Phone:510-568-3322
Practice Address - Fax:510-568-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty