Tarsa Hatefi Ahmadnia, DDS
Individual provider Active NPI Dentist · Lake Forest, CA
NPI 1457784050 · NPPES record last updated Feb 11, 2020
Key facts
- NPI
- 1457784050
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 35897 (CA)
- Practice address
- 22855 Lake Forest Drive Suite B
Lake Forest, CA 92630 - Phone
- (949) 583-1558
- Fax
- (949) 597-9768
- NPI assigned
- Aug 19, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35897 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shervin Ahmadnia DDS Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 35897 | CA | Yes |
Addresses
Primary practice location
22855 Lake Forest Drive Suite B
Lake Forest, CA 92630
Mailing address
22855 Lake Forest Dr Ste B
Lake Forest, CA 92630-1647
Phone (949) 583-1558
Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.