Provider Demographics
NPI:1780011106
Name:ABOLFAZLIAN, ARASH (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ARASH
Middle Name:
Last Name:ABOLFAZLIAN
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DEERWOOD RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4409
Mailing Address - Country:US
Mailing Address - Phone:925-230-2966
Mailing Address - Fax:925-905-5820
Practice Address - Street 1:111 DEERWOOD RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-230-2966
Practice Address - Fax:925-905-5820
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics