Provider Demographics
NPI:1508343237
Name:NIA, ARASH VAHDATI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARASH
Middle Name:VAHDATI
Last Name:NIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ARASH
Other - Middle Name:
Other - Last Name:VAHDATI NIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6203 ARCHWAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-8835
Mailing Address - Country:US
Mailing Address - Phone:408-375-3335
Mailing Address - Fax:
Practice Address - Street 1:6203 ARCHWAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-8835
Practice Address - Country:US
Practice Address - Phone:408-375-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1027691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice