Provider Demographics
NPI:1699518381
Name:AMROLLAHIE DMD INC
Entity type:Organization
Organization Name:AMROLLAHIE DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMROLLAHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-510-7795
Mailing Address - Street 1:1442 IRVINE BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3846
Mailing Address - Country:US
Mailing Address - Phone:714-544-6345
Mailing Address - Fax:714-544-1008
Practice Address - Street 1:1442 IRVINE BLVD STE 225
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3846
Practice Address - Country:US
Practice Address - Phone:714-544-6345
Practice Address - Fax:714-544-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty