Provider Demographics
NPI:1669700449
Name:MARJAN NOROOZI
Entity type:Organization
Organization Name:MARJAN NOROOZI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOROOZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-680-6000
Mailing Address - Street 1:3142 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2733
Mailing Address - Country:US
Mailing Address - Phone:925-680-6000
Mailing Address - Fax:
Practice Address - Street 1:3142 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2733
Practice Address - Country:US
Practice Address - Phone:925-680-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48160122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659599472OtherDENTICAL