Provider Demographics
NPI:1982792115
Name:AGHA, MAISSA RSTOUM (DDS)
Entity Type:Individual
Prefix:
First Name:MAISSA
Middle Name:RSTOUM
Last Name:AGHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 W BALL RD
Mailing Address - Street 2:#A
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-827-3441
Mailing Address - Fax:714-827-0232
Practice Address - Street 1:3441 W BALL RD
Practice Address - Street 2:#A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:714-827-3441
Practice Address - Fax:714-827-0232
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4310602OtherDENTI CAL