Provider Demographics
NPI:1720462138
Name:VAFI AHANI DENTAL CORP
Entity Type:Organization
Organization Name:VAFI AHANI DENTAL CORP
Other - Org Name:SHOREVIEW DENTAL SAN MATEO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-524-4855
Mailing Address - Street 1:150 N SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2761
Mailing Address - Country:US
Mailing Address - Phone:650-524-4855
Mailing Address - Fax:650-524-4859
Practice Address - Street 1:150 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2761
Practice Address - Country:US
Practice Address - Phone:650-524-4855
Practice Address - Fax:650-524-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty