1740469501 NPI number — MAISSA R. AGHA, D.D.S. INC

Table of content: (NPI 1740469501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740469501 NPI number — MAISSA R. AGHA, D.D.S. INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAISSA R. AGHA, D.D.S. INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740469501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3441 W BALL RD
Provider Second Line Business Mailing Address:
SUITE #A
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92804-3723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-827-3441
Provider Business Mailing Address Fax Number:
714-827-0232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3441 W BALL RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92804-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-827-3441
Provider Business Practice Location Address Fax Number:
714-827-0232
Provider Enumeration Date:
10/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AGHA
Authorized Official First Name:
MAISSA
Authorized Official Middle Name:
RSTOUN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-827-3441

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  43106 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D43106-02 . This is a "DENTI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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