Provider Demographics
NPI:1255608543
Name:MADANI, MORVARID (DMD)
Entity type:Individual
Prefix:DR
First Name:MORVARID
Middle Name:
Last Name:MADANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22195 EL PASEO STE 260
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3952
Mailing Address - Country:US
Mailing Address - Phone:949-400-3865
Mailing Address - Fax:
Practice Address - Street 1:22195 EL PASEO STE 260
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3952
Practice Address - Country:US
Practice Address - Phone:949-400-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist