Individual
CONNIE TARA AKHAVANHAIDARY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5175 E PACIFIC COAST HWY STE 201, LONG BEACH, CA 90804-3315
(562) 597-1543
Mailing address
6 ANDANDO, ALISO VIEJO, CA 92656-5292
(949) 613-0404
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
111994
CA
Other
Enumeration date
11/14/2023
Last updated
04/26/2026
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