Healthcare Provider Details

I. General information

NPI: 1649937426
Provider Name (Legal Business Name): N HANNANVASH DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 CARMEL MOUNTAIN RD STE 202
SAN DIEGO CA
92130-4861
US

IV. Provider business mailing address

5550 CARMEL MOUNTAIN RD STE 202
SAN DIEGO CA
92130-4861
US

V. Phone/Fax

Practice location:
  • Phone: 619-630-4000
  • Fax: 619-630-0241
Mailing address:
  • Phone: 619-630-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. NAJMEH HANNANVASH
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: DDS
Phone: 503-888-1024