Provider Demographics
NPI:1710265673
Name:AHMADI, KERESHMEH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KERESHMEH
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:AHMADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3330 3RD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5639
Mailing Address - Country:US
Mailing Address - Phone:619-285-0950
Mailing Address - Fax:
Practice Address - Street 1:3330 3RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5639
Practice Address - Country:US
Practice Address - Phone:619-816-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist