Provider Demographics
NPI:1669224697
Name:MOMANI DDS INC
Entity type:Organization
Organization Name:MOMANI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:I
Authorized Official - Last Name:MOMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-578-0280
Mailing Address - Street 1:1207 13TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0934
Mailing Address - Country:US
Mailing Address - Phone:209-337-4777
Mailing Address - Fax:209-831-3276
Practice Address - Street 1:12 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3903
Practice Address - Country:US
Practice Address - Phone:209-337-4777
Practice Address - Fax:209-831-3276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOMANI DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-03
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty