Provider Demographics
NPI:1821478694
Name:BIGDELI DDS INC
Entity Type:Organization
Organization Name:BIGDELI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:FORUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGDELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-665-0005
Mailing Address - Street 1:13422 NEWPORT AVE
Mailing Address - Street 2:E
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3746
Mailing Address - Country:US
Mailing Address - Phone:714-665-0005
Mailing Address - Fax:714-665-0055
Practice Address - Street 1:13422 NEWPORT AVE
Practice Address - Street 2:E
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3746
Practice Address - Country:US
Practice Address - Phone:714-665-0005
Practice Address - Fax:714-665-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIGDELI DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538175880OtherMEDI-CAL/DENTI-CAL