Provider Demographics
NPI:1013308170
Name:ENDO CARE
Entity Type:Organization
Organization Name:ENDO CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-547-7668
Mailing Address - Street 1:485 34TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2823
Mailing Address - Country:US
Mailing Address - Phone:510-547-7668
Mailing Address - Fax:510-547-7665
Practice Address - Street 1:485 34TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2823
Practice Address - Country:US
Practice Address - Phone:510-547-7668
Practice Address - Fax:510-547-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty