Provider Demographics
NPI:1487228383
Name:R RASTAKHIZ DDS INC
Entity type:Organization
Organization Name:R RASTAKHIZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTAKHIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-407-5714
Mailing Address - Street 1:2235 ALMA ST
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3905
Mailing Address - Country:US
Mailing Address - Phone:650-327-1530
Mailing Address - Fax:
Practice Address - Street 1:2235 ALMA ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3905
Practice Address - Country:US
Practice Address - Phone:650-327-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental