Provider Demographics
NPI:1154941276
Name:ALIREZA KHOSHVAGHTI DDS INC
Entity type:Organization
Organization Name:ALIREZA KHOSHVAGHTI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHVAGHTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:240-672-4801
Mailing Address - Street 1:220 MONTGOMERY ST STE 483
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3410
Mailing Address - Country:US
Mailing Address - Phone:415-398-6344
Mailing Address - Fax:415-398-6268
Practice Address - Street 1:220 MONTGOMERY ST STE 483
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3410
Practice Address - Country:US
Practice Address - Phone:415-398-6344
Practice Address - Fax:415-398-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty