Provider Demographics
NPI:1376828244
Name:RAMTIN NASSIRI, DDS, MSD, A PROF CORP
Entity type:Organization
Organization Name:RAMTIN NASSIRI, DDS, MSD, A PROF CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:510-280-5731
Mailing Address - Street 1:1183 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1637
Mailing Address - Country:US
Mailing Address - Phone:510-280-5731
Mailing Address - Fax:
Practice Address - Street 1:1183 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1637
Practice Address - Country:US
Practice Address - Phone:510-280-5731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54020261QD0000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty