Provider Demographics
NPI:1285694695
Name:ARAM, MASOUD (DDS)
Entity type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:ARAM
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 1:13771 NEWPORT AVE
Mailing Address - Street 2:#11
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-4693
Mailing Address - Country:US
Mailing Address - Phone:714-838-7777
Mailing Address - Fax:714-838-7777
Practice Address - Street 1:13771 NEWPORT AVE
Practice Address - Street 2:#11
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-4693
Practice Address - Country:US
Practice Address - Phone:714-838-7777
Practice Address - Fax:714-838-7777
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44818Medicare ID - Type Unspecified