Provider Demographics
NPI:1699593806
Name:PEDARI, FOUJAN (DMD)
Entity type:Individual
Prefix:
First Name:FOUJAN
Middle Name:
Last Name:PEDARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 HOPYARD RD STE R
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-5259
Mailing Address - Country:US
Mailing Address - Phone:415-919-9392
Mailing Address - Fax:
Practice Address - Street 1:3015 HOPYARD RD STE R
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-5259
Practice Address - Country:US
Practice Address - Phone:925-462-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist