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General NPI Number Information
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NPI Number | 1912447566
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Entity Type | Organization
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Legal Business Name | AMITISS NASIRI ANSARI DDS, INC.
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 2781 W MACARTHUR BLVD SUITE N
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City | SANTA ANA
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State | CA
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Zip | 92704-8300
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Country | US
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Telephone | 714-556-7277
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Fax | 714-556-2021
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Provider Business Mailing Address
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Address Line | 2781 W MACARTHUR BLVD SUITE N
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City | SANTA ANA
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State | CA
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Zip | 92704-8300
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Country | US
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Telephone | 714-556-7277
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Fax | 714-556-2021
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Authorized Official
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Title or Position | DDS/OWNER
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Name | DR. AMITISS NASIRI
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Credential | DDS
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Telephone | 714-556-7277
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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 | 55817
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License Number State | CA
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