Healthcare Provider Details

I. General information

NPI: 1447177951
Provider Name (Legal Business Name): IMAN SHIRMOHAMMADI DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25746 FLETCHER PL
LAGUNA HILLS CA
92653-7547
US

IV. Provider business mailing address

25746 FLETCHER PL
LAGUNA HILLS CA
92653-7547
US

V. Phone/Fax

Practice location:
  • Phone: 949-395-8585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number112419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: