Provider Demographics
NPI:1295917144
Name:SHERVIN AHMADNIA DDS INC
Entity type:Organization
Organization Name:SHERVIN AHMADNIA DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADNIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-583-1558
Mailing Address - Street 1:22855 LAKE FOREST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1656
Mailing Address - Country:US
Mailing Address - Phone:949-583-1558
Mailing Address - Fax:
Practice Address - Street 1:22855 LAKE FOREST DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1656
Practice Address - Country:US
Practice Address - Phone:949-583-1558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty