MEDICARE: AIDA DADASHZADEH DDS

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	1223P0221X	Pediatric Dentistry	111281	CA

General Provider Information

NPI Number	:	1841987344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDA DADASHZADEH DDS

Provider Business Mailing Address
First Line	:	991 S PARK RIM CIR
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92807-5113
Country	:	US
Telephone Number	:	714-299-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	19201 BROOKHURST ST STE 101
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2926
Country	:	US
Telephone Number	:	714-978-4785
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	03/06/2026

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