Provider Demographics
NPI:1205956075
Name:HAMID REZAPOUR, DDS, INC.
Entity type:Organization
Organization Name:HAMID REZAPOUR, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-680-4444
Mailing Address - Street 1:14330 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-234-1414
Mailing Address - Fax:510-234-4707
Practice Address - Street 1:14330 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-234-1414
Practice Address - Fax:510-234-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536261223G0001X
CA534711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty