Provider Demographics
NPI:1598823106
Name:IRANMANESH, ALI (DMD, MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:IRANMANESH
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 EAST ST
Mailing Address - Street 2:SUITE #355
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2084
Mailing Address - Country:US
Mailing Address - Phone:925-827-0202
Mailing Address - Fax:925-827-0119
Practice Address - Street 1:2222 EAST ST
Practice Address - Street 2:SUITE #355
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2084
Practice Address - Country:US
Practice Address - Phone:925-827-0202
Practice Address - Fax:925-827-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA481221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery