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Organization
MARYAM GHASEMYEH DDS INCORPORATED
Active
Organization
MARYAM GHASEMYEH DDS INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARYAM GHASEMYEH DDS (CEO)
(714) 547-9411
Entity
Organization
Contact information
Practice address
801 N TUSTIN AVE, SUITE #400, SANTA ANA, CA 92705-3612
(714) 547-9411
Mailing address
PO BOX 10175, SANTA ANA, CA 92711-0175
(714) 547-9411
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DDS36152
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS36152
CA DENTAL LICENSE
CA
Enumeration date
10/19/2006
Last updated
03/16/2017
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