Provider Demographics
NPI:1336972892
Name:AMIR HOSSEINI DENTAL CORPORATION
Entity type:Organization
Organization Name:AMIR HOSSEINI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-787-5600
Mailing Address - Street 1:26 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3477
Mailing Address - Country:US
Mailing Address - Phone:707-787-5600
Mailing Address - Fax:702-787-5602
Practice Address - Street 1:26 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3477
Practice Address - Country:US
Practice Address - Phone:707-787-5600
Practice Address - Fax:702-787-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental