Provider Demographics
NPI:1871034397
Name:R K NASSIRI, DDS, MSD, INC
Entity Type:Organization
Organization Name:R K NASSIRI, DDS, MSD, INC
Other - Org Name:LAMORINDA SMILE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:925-298-5281
Mailing Address - Street 1:3466 MT DIABLO BLVD
Mailing Address - Street 2:SUITE C207
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-7106
Mailing Address - Country:US
Mailing Address - Phone:925-298-5281
Mailing Address - Fax:925-298-5419
Practice Address - Street 1:3466 MT DIABLO BLVD
Practice Address - Street 2:SUITE C207
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-7106
Practice Address - Country:US
Practice Address - Phone:925-298-5281
Practice Address - Fax:925-298-5419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539971223P0221X
CA554271223S0112X
CA540201223X0400X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124121231OtherINDIVIDUAL NPI