Healthcare Provider Details

I. General information

NPI: 1407579972
Provider Name (Legal Business Name): ARMITA EHTESSABIAN DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 YORBA LINDA BLVD STE 305
YORBA LINDA CA
92886-4032
US

IV. Provider business mailing address

18220 YORBA LINDA BLVD STE 305
YORBA LINDA CA
92886-4032
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-2000
  • Fax:
Mailing address:
  • Phone: 714-528-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number104665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: