Provider Demographics
NPI:1104819440
Name:GHORBANIAN, HAMED (DDS)
Entity type:Individual
Prefix:MR
First Name:HAMED
Middle Name:
Last Name:GHORBANIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3307
Mailing Address - Country:US
Mailing Address - Phone:951-372-9094
Mailing Address - Fax:951-372-9378
Practice Address - Street 1:2031 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3307
Practice Address - Country:US
Practice Address - Phone:951-372-9094
Practice Address - Fax:951-372-9378
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38997Medicare ID - Type Unspecified