Provider Demographics
NPI:1033230628
Name:MANSOUR, ANWAAR RAGHEB (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANWAAR
Middle Name:RAGHEB
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16100 SAND CANYON AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3719
Mailing Address - Country:US
Mailing Address - Phone:949-585-1515
Mailing Address - Fax:949-585-1519
Practice Address - Street 1:16100 SAND CANYON AVE STE 330
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3719
Practice Address - Country:US
Practice Address - Phone:949-585-1515
Practice Address - Fax:949-585-1519
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist