Provider Demographics
NPI:1205493624
Name:YASAMIN TARASSOLI, DDS, INC
Entity type:Organization
Organization Name:YASAMIN TARASSOLI, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARASSOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-469-3138
Mailing Address - Street 1:4140 WHISPERING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-5838
Mailing Address - Country:US
Mailing Address - Phone:310-469-3138
Mailing Address - Fax:
Practice Address - Street 1:1175 ARNOLD DR STE C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4111
Practice Address - Country:US
Practice Address - Phone:925-229-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental