Healthcare Provider Details

I. General information

NPI: 1215329487
Provider Name (Legal Business Name): MOMANI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SIERRA ST
RIVERBANK CA
95367-2440
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 209-872-3399
  • Fax:
Mailing address:
  • Phone: 209-527-3990
  • Fax: 209-524-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59081
License Number StateCA

VIII. Authorized Official

Name: AHMAD MOMANI
Title or Position: CEO
Credential:
Phone: 209-527-3990