Provider Demographics
NPI:1881066710
Name:AZADEH AHMADI-ARDAKANI DDS INC.
Entity type:Organization
Organization Name:AZADEH AHMADI-ARDAKANI DDS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AZADEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI-ARDAKANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-291-8196
Mailing Address - Street 1:27581 BERDUN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-1431
Mailing Address - Country:US
Mailing Address - Phone:949-291-8196
Mailing Address - Fax:
Practice Address - Street 1:26534 MOULTON PKWY STE C
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-8241
Practice Address - Country:US
Practice Address - Phone:949-291-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59353305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization