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General NPI Number Information
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NPI Number | 1376931063
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Entity Type | Organization
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Legal Business Name | DR ANOSH DDS INC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 11050 COLOMA RD STE 17
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2870
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Country | US
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Telephone | 916-635-9800
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Fax | 916-635-9802
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Provider Business Mailing Address
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Address Line | 11050 COLOMA RD STE 17
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-2870
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Country | US
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Telephone | 916-635-9800
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Fax | 916-635-9802
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Authorized Official
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Title or Position | OWNNER
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Name | DR. MOHAMMAD ANOSH
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Credential | DDS
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Telephone | 916-635-9800
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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 | 57015
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License Number State | CA
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