Provider Demographics
NPI:1255583126
Name:OBAIDI, ANMAR (DDS)
Entity type:Individual
Prefix:
First Name:ANMAR
Middle Name:
Last Name:OBAIDI
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 1:27685 MANOR HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-6045
Mailing Address - Country:US
Mailing Address - Phone:949-683-3326
Mailing Address - Fax:949-487-6781
Practice Address - Street 1:657 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 138
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2826
Practice Address - Country:US
Practice Address - Phone:949-487-6780
Practice Address - Fax:949-487-6781
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice