Healthcare Provider Details

I. General information

NPI: 1336067842
Provider Name (Legal Business Name): GHOWSI DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27620 MARGUERITE PKWY STE D
MISSION VIEJO CA
92692-3607
US

IV. Provider business mailing address

27620 MARGUERITE PKWY STE D
MISSION VIEJO CA
92692-3607
US

V. Phone/Fax

Practice location:
  • Phone: 408-220-4622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALI GHOWSI
Title or Position: PRESIDENT/CEO
Credential:
Phone: 408-220-4622