Provider Demographics
NPI:1992221493
Name:AGHDAM, CYRUS R (DDS)
Entity type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:R
Last Name:AGHDAM
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 1:203 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4203
Mailing Address - Country:US
Mailing Address - Phone:760-743-2295
Mailing Address - Fax:
Practice Address - Street 1:203 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4203
Practice Address - Country:US
Practice Address - Phone:760-743-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060423-011223X0400X
NVS3-3591223X0400X
CA1074771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics