Provider Demographics
NPI:1861018160
Name:DENTISTS ON WHEELS
Entity Type:Organization
Organization Name:DENTISTS ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHABNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FARZANEH
Authorized Official - Suffix:
Authorized Official - Credentials:NON-PROFIT PRESIDENT
Authorized Official - Phone:310-663-0756
Mailing Address - Street 1:3049 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1761
Mailing Address - Country:US
Mailing Address - Phone:310-663-0756
Mailing Address - Fax:
Practice Address - Street 1:2210 GLADSTONE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5101
Practice Address - Country:US
Practice Address - Phone:310-663-0756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty