Provider Demographics
NPI:1881310035
Name:ANWAR AGHDAM DDS INC
Entity type:Organization
Organization Name:ANWAR AGHDAM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHDAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-651-0760
Mailing Address - Street 1:203 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4203
Mailing Address - Country:US
Mailing Address - Phone:760-743-2295
Mailing Address - Fax:
Practice Address - Street 1:203 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4203
Practice Address - Country:US
Practice Address - Phone:760-743-2295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty