MEDICARE: ARIANNEJAD AND PHAM DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1760934871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIANNEJAD AND PHAM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	5620 LAKE MURRAY BLVD
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-1981
Country	:	US
Telephone Number	:	619-324-4195
Fax Number	:	619-560-5434

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAHAB ARIANNEJAD
Credential	:	DMD
Telephone Number	:	619-324-4195

Provider Enumeration Date	:	10/25/2016
Last Update Date	:	10/25/2016

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