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Pardis Jonathan Vakili

Dentist

Dental Providers

2995 Clairemont Dr Ste A, San Diego, CA 92117-6766

PECOS Enrollment

This provider is enrolled in PECOS as PARDIS VAKILI.

Based on the most recent information from CMS, provider Pardis Jonathan Vakili is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1669193272
Provider Type
Individual
Full Name
Vakili, Pardis Jonathan
Title
Dr.
Credential
DDS

Gender
Male
Sole Proprietor
No
Enumeration Date
9/12/2022
Last Updated
9/12/2022

Contact Information

Practice Location

2995 Clairemont Dr Ste A, San Diego, CA 92117-6766

(858) 200-0827

Unlisted Fax

Mailing Location

2630 Erie St Unit 7, San Diego, CA 92110-3352

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 122300000X Primary	Description Dentist Dental Providers	License 107909 California

Pardis Jonathan Vakili

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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