Provider Demographics
NPI:1437441425
Name:PACIFICA ORTHODONTICS
Entity Type:Organization
Organization Name:PACIFICA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-898-8951
Mailing Address - Street 1:1301 PALMETTO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2272
Mailing Address - Country:US
Mailing Address - Phone:650-898-8951
Mailing Address - Fax:
Practice Address - Street 1:1301 PALMETTO AVE STE F
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2272
Practice Address - Country:US
Practice Address - Phone:650-898-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty