Provider Demographics
NPI:1982362091
Name:DR. KERMANI DDS PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. KERMANI DDS PROFESSIONAL CORPORATION
Other - Org Name:ALTON IMPLANT & DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GHAZAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-701-5320
Mailing Address - Street 1:5405 ALTON PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3719
Mailing Address - Country:US
Mailing Address - Phone:949-262-0300
Mailing Address - Fax:
Practice Address - Street 1:5405 ALTON PKWY STE F
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3719
Practice Address - Country:US
Practice Address - Phone:949-262-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty