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General NPI Number Information
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NPI Number | 1053504522
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Entity Type | Organization
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Legal Business Name | MASOUDARAMDDS.INC
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 13771 NEWPORT AVE #11
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City | TUSTIN
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State | CA
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Zip | 92780-4693
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Country | US
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Telephone | 714-838-7777
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Fax | 714-838-7777
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Provider Business Mailing Address
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Address Line | 13771 NEWPORT AVE #11
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City | TUSTIN
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State | CA
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Zip | 92780-4693
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Country | US
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Telephone | 714-838-7777
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Fax | 714-838-7777
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. MASOUD ARAM
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Credential | DDS
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Telephone | 714-838-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44818
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License Number State | CA
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