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General NPI Number Information
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NPI Number | 1821183864
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Entity Type | Individual
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Provider Name | ALIREZA KHANSARI DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 12630 MONTE VISTA ROAD. #204
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-679-0142
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Fax | 858-679-0165
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Provider Business Mailing Address
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Address Line | 12630 MONTE VISTA ROAD. #204
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-679-0142
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Fax | 858-679-0165
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 49590
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License Number State | CA
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