Provider Demographics
NPI:1922146349
Name:GHANDEHARI, BOBBY (DDS, MS,)
Entity Type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:GHANDEHARI
Suffix:
Gender:M
Credentials:DDS, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-305-0550
Mailing Address - Fax:949-305-0551
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA
Practice Address - Street 2:SUITE 120
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-305-0550
Practice Address - Fax:949-305-0551
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA453671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics