Provider Demographics
NPI:1962834879
Name:GHODS, NAVID MANSOUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NAVID
Middle Name:MANSOUR
Last Name:GHODS
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 1:3620 S BRISTOL ST
Mailing Address - Street 2:SUITE #104
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7300
Mailing Address - Country:US
Mailing Address - Phone:714-424-0046
Mailing Address - Fax:714-424-0047
Practice Address - Street 1:3620 S BRISTOL ST
Practice Address - Street 2:SUITE #104
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7300
Practice Address - Country:US
Practice Address - Phone:714-424-0046
Practice Address - Fax:714-424-0047
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA412561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice