Provider Demographics
NPI:1134338833
Name:DR. ALI HEIDARI & DR. RAMIN MORADI, D.D.S., INC, P.C.
Entity type:Organization
Organization Name:DR. ALI HEIDARI & DR. RAMIN MORADI, D.D.S., INC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-688-6531
Mailing Address - Street 1:9059 SOQUEL DR STE A
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4067
Mailing Address - Country:US
Mailing Address - Phone:831-688-6531
Mailing Address - Fax:
Practice Address - Street 1:9059 SOQUEL DR STE A
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4067
Practice Address - Country:US
Practice Address - Phone:831-688-6531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462641223G0001X
CA436441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty