Healthcare Provider Details

I. General information

NPI: 1063137305
Provider Name (Legal Business Name): AVA POURNEJAD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 UNIVERSITY DR STE A
IRVINE CA
92612-2942
US

IV. Provider business mailing address

402 CERVANTES CT
IRVINE CA
92617-4118
US

V. Phone/Fax

Practice location:
  • Phone: 949-653-2244
  • Fax:
Mailing address:
  • Phone: 949-235-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2022034664
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: