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Organization

BIGDELI DDS INC

Active
Parent organization
BIGDELI DDS INC
Organization subpart
Yes

Provider details

NPI number
Legal business name
BIGDELI DDS INC
Authorized official
FORUZAN BIGDELI (DENTIST)
(714) 665-0005
Entity
Organization

Contact information

Practice address
13422 NEWPORT AVE, E, TUSTIN, CA 92780-3746
(714) 665-0005
(714) 665-0055
Mailing address
13422 NEWPORT AVE, E, TUSTIN, CA 92780-3746
(714) 665-0005
(714) 665-0055

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1538175880
MEDI-CAL/DENTI-CAL
CA
Enumeration date
06/05/2015
Last updated
06/05/2015
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