Provider Demographics
NPI:1124171905
Name:AMIR ESFANDIARI DDS, INC
Entity type:Organization
Organization Name:AMIR ESFANDIARI DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:MEHDI
Authorized Official - Last Name:NOORI ESFANDIARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-861-2500
Mailing Address - Street 1:2500 ALTON PKWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5024
Mailing Address - Country:US
Mailing Address - Phone:949-861-2500
Mailing Address - Fax:949-861-2501
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5024
Practice Address - Country:US
Practice Address - Phone:949-861-2500
Practice Address - Fax:949-861-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty