Provider Demographics
NPI:1235877549
Name:DR ANOSH DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR ANOSH DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-952-2933
Mailing Address - Street 1:5345 N EL DORADO ST STE 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5848
Mailing Address - Country:US
Mailing Address - Phone:209-952-2933
Mailing Address - Fax:
Practice Address - Street 1:5345 N EL DORADO ST STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5848
Practice Address - Country:US
Practice Address - Phone:209-952-2933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental