Provider Demographics
NPI:1740218312
Name:SAFFARPOUR, MAMAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAMAK
Middle Name:
Last Name:SAFFARPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROSS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3038
Mailing Address - Country:US
Mailing Address - Phone:408-269-2944
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSS AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3038
Practice Address - Country:US
Practice Address - Phone:408-269-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice