Provider Demographics
NPI:1760808158
Name:ARAD, ARASH (MBA, DDS)
Entity Type:Individual
Prefix:DR
First Name:ARASH
Middle Name:
Last Name:ARAD
Suffix:
Gender:M
Credentials:MBA, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VIA DIVERTIRSE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7014
Mailing Address - Country:US
Mailing Address - Phone:909-705-6697
Mailing Address - Fax:
Practice Address - Street 1:1713 SMILEY RDG
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-6575
Practice Address - Country:US
Practice Address - Phone:909-705-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650511223X0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program