Provider Demographics
NPI:1679746796
Name:MOHSEN M ANSARI, DMD INC
Entity type:Organization
Organization Name:MOHSEN M ANSARI, DMD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHSEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-283-4720
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1225
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-783-4720
Mailing Address - Fax:415-765-1557
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1225
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-783-4720
Practice Address - Fax:415-765-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty