Provider Demographics
NPI:1982181012
Name:TEHRANI, SAM (DDS)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 GARLAND CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2317
Mailing Address - Country:US
Mailing Address - Phone:925-899-1517
Mailing Address - Fax:
Practice Address - Street 1:3297 ARLINGTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3250
Practice Address - Country:US
Practice Address - Phone:951-683-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS102750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist