Provider Demographics
NPI:1053126201
Name:PENINSULA SPECIALTY DENTAL CARE
Entity type:Organization
Organization Name:PENINSULA SPECIALTY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHMAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKHORDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-654-1854
Mailing Address - Street 1:562 RALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2832
Mailing Address - Country:US
Mailing Address - Phone:650-654-1854
Mailing Address - Fax:
Practice Address - Street 1:562 RALSTON AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2832
Practice Address - Country:US
Practice Address - Phone:650-654-1854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty