Provider Demographics
NPI:1801162987
Name:MEHI M. VANDI DDS INC.
Entity type:Organization
Organization Name:MEHI M. VANDI DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-963-6678
Mailing Address - Street 1:1930 S BASCOM AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2364
Mailing Address - Country:US
Mailing Address - Phone:408-963-6678
Mailing Address - Fax:408-963-6668
Practice Address - Street 1:1930 S BASCOM AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2364
Practice Address - Country:US
Practice Address - Phone:408-963-6678
Practice Address - Fax:408-963-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDH 19264124Q00000X
CARDH 25903124Q00000X
CA40849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty