Provider Demographics
NPI:1154560670
Name:PANAHPOUR, ALIREZA (DDS)
Entity type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:PANAHPOUR
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 1:6 HUGHES STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2060
Mailing Address - Country:US
Mailing Address - Phone:949-680-1891
Mailing Address - Fax:949-680-1919
Practice Address - Street 1:6 HUGHES STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2060
Practice Address - Country:US
Practice Address - Phone:949-680-1891
Practice Address - Fax:949-680-1919
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA416611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice