Provider Demographics
NPI:1669579843
Name:ANGELA POURGHASSEMI DMD, INC.
Entity type:Organization
Organization Name:ANGELA POURGHASSEMI DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:FERESHTEH
Authorized Official - Last Name:POURGHASSEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-790-0101
Mailing Address - Street 1:2305 CAMINO RAMON
Mailing Address - Street 2:#230
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1396
Mailing Address - Country:US
Mailing Address - Phone:925-790-0101
Mailing Address - Fax:925-790-0103
Practice Address - Street 1:2305 CAMINO RAMON
Practice Address - Street 2:#230
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1396
Practice Address - Country:US
Practice Address - Phone:925-790-0101
Practice Address - Fax:925-790-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45175122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty