MEDICARE: DARA AHMADNIA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	110580	CA

General Provider Information

NPI Number	:	1407688336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARA AHMADNIA DDS

Provider Business Mailing Address
First Line	:	25652 PINTO CT
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-5849
Country	:	US
Telephone Number	:	949-633-0170
Fax Number	:

Provider Business Practice Location Address
First Line	:	22855 LAKE FOREST DR STE B
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-1647
Country	:	US
Telephone Number	:	949-583-1558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	08/19/2024

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