Provider Demographics
NPI:1033376587
Name:MALEK K. MANSOUR, ANWAAR R. MANSOUR AND YAHYA M. MANSOUR D.D.S., INC.
Entity Type:Organization
Organization Name:MALEK K. MANSOUR, ANWAAR R. MANSOUR AND YAHYA M. MANSOUR D.D.S., INC.
Other - Org Name:AAVA DENTAL OF IRVINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MALEK
Authorized Official - Middle Name:KAMAL
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MAGD,PHD
Authorized Official - Phone:949-585-1515
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:265
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-7701
Mailing Address - Country:US
Mailing Address - Phone:949-585-1515
Mailing Address - Fax:949-585-1519
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:265
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-7701
Practice Address - Country:US
Practice Address - Phone:949-585-1515
Practice Address - Fax:949-585-1519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty