Individual
DR. OMID MIRFENDERESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MPH
Contact information
Practice address
3110 KERNER BLVD, SAN RAFAEL, CA 94901-5411
(415) 448-1500
Mailing address
PO BOX 3623, SANTA CLARA, CA 95055-3623
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
106243
CA
Other
Enumeration date
05/17/2021
Last updated
06/16/2024
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