Provider Demographics
NPI:1659850642
Name:ALI MODARRES, D.D.S.,APC
Entity Type:Organization
Organization Name:ALI MODARRES, D.D.S.,APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MODARRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-692-1767
Mailing Address - Street 1:24835 LA PALMA AVE STE F
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-5532
Mailing Address - Country:US
Mailing Address - Phone:714-692-1767
Mailing Address - Fax:714-692-1931
Practice Address - Street 1:24835 LA PALMA AVE STE F
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-5532
Practice Address - Country:US
Practice Address - Phone:714-692-1767
Practice Address - Fax:714-692-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391861223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty