Provider Demographics
NPI:1184786790
Name:TALMOOD, ANNA KHODADADEH (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:KHODADADEH
Last Name:TALMOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1310
Mailing Address - Country:US
Mailing Address - Phone:714-992-0300
Mailing Address - Fax:714-992-2724
Practice Address - Street 1:1019 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1310
Practice Address - Country:US
Practice Address - Phone:714-992-0300
Practice Address - Fax:714-992-2724
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41931122300000X
CAB41931-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB41931-01Medicare ID - Type Unspecified