Provider Demographics
NPI:1699173260
Name:AZITA KHASHAYAR D.M.D., INC.
Entity type:Organization
Organization Name:AZITA KHASHAYAR D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHASHAYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-685-9500
Mailing Address - Street 1:401 GREGORY LN STE 204
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2842
Mailing Address - Country:US
Mailing Address - Phone:925-685-9500
Mailing Address - Fax:925-685-9580
Practice Address - Street 1:401 GREGORY LN STE 204
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2842
Practice Address - Country:US
Practice Address - Phone:925-685-9500
Practice Address - Fax:925-685-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty