Provider Demographics
NPI:1104804780
Name:HEIDARINIA, AKBAR (DMD)
Entity type:Individual
Prefix:DR
First Name:AKBAR
Middle Name:
Last Name:HEIDARINIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCOTIA SEA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-2104
Mailing Address - Country:US
Mailing Address - Phone:949-715-3132
Mailing Address - Fax:
Practice Address - Street 1:235 S TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2321
Practice Address - Country:US
Practice Address - Phone:949-874-3366
Practice Address - Fax:714-744-0024
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330659645Medicare UPIN