Healthcare Provider Details

I. General information

NPI: 1376454751
Provider Name (Legal Business Name): MOMANI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 WARD AVE STE A1
PATTERSON CA
95363-8529
US

IV. Provider business mailing address

1207 13TH ST STE 2
MODESTO CA
95354-0934
US

V. Phone/Fax

Practice location:
  • Phone: 209-893-4564
  • Fax: 209-527-5685
Mailing address:
  • Phone: 209-337-4777
  • Fax: 209-831-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AHMAD I MOMANI
Title or Position: OWNER/DENTIST
Credential:
Phone: 831-578-0280