Healthcare Provider Details

I. General information

NPI: 1740347178
Provider Name (Legal Business Name): HOMAYOUN ARDJMAND, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 MAST BLVD
SANTEE CA
92071-2150
US

IV. Provider business mailing address

9280 MAST BLVD
SANTEE CA
92071-2150
US

V. Phone/Fax

Practice location:
  • Phone: 619-443-8447
  • Fax: 619-443-5450
Mailing address:
  • Phone: 619-443-8447
  • Fax: 619-443-5450

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: DR. HOMAYOUN ARDJMAND
Title or Position: DENTIST
Credential: D.D.S.
Phone: 619-443-8447