| NPI | 1982149522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAMED GHORBANI-MOGHADDAM President 408-313-3228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 11154) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 8514) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2017-01-05 |