Provider Demographics
NPI:1538490214
Name:MOMANI, AHMAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:MOMANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1308
Mailing Address - Country:US
Mailing Address - Phone:831-578-0280
Mailing Address - Fax:
Practice Address - Street 1:2816 ESPANA LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-7950
Practice Address - Country:US
Practice Address - Phone:831-578-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59081122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist