Healthcare Provider Details

I. General information

NPI: 1710284690
Provider Name (Legal Business Name): AHMAD ROKNI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24000 ALICIA PKWY STE 34
MISSION VIEJO CA
92691-3929
US

IV. Provider business mailing address

24000 ALICIA PKWY STE 34
MISSION VIEJO CA
92691-3929
US

V. Phone/Fax

Practice location:
  • Phone: 949-707-7000
  • Fax: 949-707-0088
Mailing address:
  • Phone: 949-707-7000
  • Fax: 949-707-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number57059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: