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General NPI Number Information
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NPI Number | 1992221493
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Entity Type | Individual
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Provider Name | CYRUS R AGHDAM DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 203 E 3RD AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4203
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Country | US
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Telephone | 760-743-2295
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Fax |
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Provider Business Mailing Address
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Address Line | 203 E 3RD AVE
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City | ESCONDIDO
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State | CA
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Zip | 92025-4203
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Country | US
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Telephone | 760-743-2295
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 060423-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S3-359
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 107477
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License Number State | CA
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