Provider Demographics
NPI:1306043872
Name:AKBAR HEIDARINIA DMD INC
Entity Type:Organization
Organization Name:AKBAR HEIDARINIA DMD INC
Other - Org Name:SOUTH COAST DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKBAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDARINIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-556-1001
Mailing Address - Street 1:2231 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5124
Mailing Address - Country:US
Mailing Address - Phone:714-556-1001
Mailing Address - Fax:714-556-1003
Practice Address - Street 1:2231 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5124
Practice Address - Country:US
Practice Address - Phone:714-556-1001
Practice Address - Fax:714-556-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty