Provider Demographics
NPI:1124229182
Name:ANAHEIM COMMUNITY DENTISTRY
Entity Type:Organization
Organization Name:ANAHEIM COMMUNITY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:EINOLLAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-635-0855
Mailing Address - Street 1:435 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2917
Mailing Address - Country:US
Mailing Address - Phone:714-635-0855
Mailing Address - Fax:714-635-1814
Practice Address - Street 1:435 N STATE COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2917
Practice Address - Country:US
Practice Address - Phone:714-635-0855
Practice Address - Fax:714-635-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44395-01OtherDENTICAL