Provider Demographics
NPI:1942331996
Name:OMRANI, BEN BEHDAD (DDS)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:BEHDAD
Last Name:OMRANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BELAIRE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2904
Mailing Address - Country:US
Mailing Address - Phone:310-270-5190
Mailing Address - Fax:
Practice Address - Street 1:26302 LA PAZ RD STE 203
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5328
Practice Address - Country:US
Practice Address - Phone:949-586-5669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist