Provider Demographics
NPI:1982896072
Name:OAKRIDGE DENTAL INC
Entity Type:Organization
Organization Name:OAKRIDGE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:AMIR
Authorized Official - Last Name:MASHHOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-360-0270
Mailing Address - Street 1:5450 THORNWOOD DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1222
Mailing Address - Country:US
Mailing Address - Phone:408-360-0270
Mailing Address - Fax:408-360-0275
Practice Address - Street 1:5450 THORNWOOD DR STE B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1222
Practice Address - Country:US
Practice Address - Phone:408-360-0270
Practice Address - Fax:408-360-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38560302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization