Healthcare Provider Details

I. General information

NPI: 1922789106
Provider Name (Legal Business Name): DARYOUSH ABEROUMAND, D.M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 COFFEE ROAD SUITE K
MODESTO CA
95355
US

IV. Provider business mailing address

1213 COFFEE ROAD SUITE K
MODESTO CA
95355-4229
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-2303
  • Fax: 209-523-2308
Mailing address:
  • Phone: 209-577-2303
  • Fax: 209-523-2308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DARYOUSH ABEROUMAND
Title or Position: CEO, CFO, SECRETARY
Credential: DMD
Phone: 650-772-0248