Provider Demographics
NPI:1790402014
Name:MOMANI DDS INC.
Entity Type:Organization
Organization Name:MOMANI DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DDS
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-337-4777
Mailing Address - Street 1:3025 MCHENRY AVE STE N
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1449
Mailing Address - Country:US
Mailing Address - Phone:209-860-3201
Mailing Address - Fax:
Practice Address - Street 1:125 ASCOT DR STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3408
Practice Address - Country:US
Practice Address - Phone:916-839-3050
Practice Address - Fax:916-860-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty