# EZ SMILE FAMILY DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669846416
- **Authorized official:** PAYAM BEHRADNIA D.D.S. (PRESIDENT)
- **Authorized official phone:** (707) 575-9595

## Contact information

- **Practice address:** 4757 HOEN AVE, SANTA ROSA, CA 95405-7862
- **Practice address phone:** (707) 575-9595
- **Practice address fax:** (707) 575-5122
- **Mailing address:** 4757 HOEN AVE, SANTA ROSA, CA 95405-7862
- **Mailing address phone:** (707) 575-9595
- **Mailing address fax:** (707) 575-5122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 60893 | CA | Yes |

## Other

- **Enumeration date:** 11/17/2015
- **Last updated:** 11/17/2015