Provider Demographics
NPI:1528143690
Name:AHMADPOUR, FAY (DDS)
Entity type:Individual
Prefix:DR
First Name:FAY
Middle Name:
Last Name:AHMADPOUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:FIROOZEH
Other - Middle Name:
Other - Last Name:AHMADPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5830 OBERLIN DR #201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2926
Mailing Address - Country:US
Mailing Address - Phone:858-452-3561
Mailing Address - Fax:
Practice Address - Street 1:4060 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1608
Practice Address - Country:US
Practice Address - Phone:619-255-9155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA478341223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery