Healthcare Provider Details

I. General information

NPI: 1407597958
Provider Name (Legal Business Name): ATIYA BAHMANYAR DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 N EUCLID ST
ANAHEIM CA
92801-1900
US

IV. Provider business mailing address

1174 N EUCLID ST
ANAHEIM CA
92801-1900
US

V. Phone/Fax

Practice location:
  • Phone: 714-900-3340
  • Fax:
Mailing address:
  • Phone: 714-900-3340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ATIYA BAHMANYAR
Title or Position: OWNER
Credential: DDS
Phone: 714-900-3340