Provider Demographics
NPI:1407688336
Name:AHMADNIA, DARA (DDS)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:
Last Name:AHMADNIA
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 1:25652 PINTO CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5849
Mailing Address - Country:US
Mailing Address - Phone:949-633-0170
Mailing Address - Fax:
Practice Address - Street 1:22855 LAKE FOREST DR STE B
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1647
Practice Address - Country:US
Practice Address - Phone:949-583-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist