Provider Demographics
NPI:1992872246
Name:AHMADI-KASHANI, LIDA (DMD)
Entity type:Individual
Prefix:
First Name:LIDA
Middle Name:
Last Name:AHMADI-KASHANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA STE 208
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3140
Mailing Address - Country:US
Mailing Address - Phone:949-830-9671
Mailing Address - Fax:949-830-1309
Practice Address - Street 1:23521 PASEO DE VALENCIA STE 208
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3140
Practice Address - Country:US
Practice Address - Phone:949-830-9671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice