Provider Demographics
NPI:1215035696
Name:AHANI, ARSALAN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:ARSALAN
Middle Name:
Last Name:AHANI
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:SAL
Other - Last Name:AHANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MD
Mailing Address - Street 1:30 N SAN MATEO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2824
Mailing Address - Country:US
Mailing Address - Phone:650-340-6141
Mailing Address - Fax:650-340-6142
Practice Address - Street 1:30 N SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2824
Practice Address - Country:US
Practice Address - Phone:650-340-6141
Practice Address - Fax:650-340-6142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429661223S0112X
CAA97353204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery