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Provider Information for 1922146349

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DR. BOBBY GHANDEHARI DDS, MS,

Gender: MALE

Individual NPI: 1922146349

Calendar   Last Updated:  2015-03-23
  Certification Date: 

Details

Name Value
NPI 1922146349
Enumeration Date 2007-02-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 24422 AVENIDA DE LA CARLOTA SUITE 120
LAGUNA HILLS, CA 92653
United States

Phone: 949-305-0550 | Fax: 949-305-0551
View Map External Link
Primary Practice Address 24422 AVENIDA DE LA CARLOTA SUITE 120
LAGUNA HILLS, CA 92653
United States

Phone: 949-305-0550 | Fax: 949-305-0551
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223X0400X - Dentist Orthodontics and Dentofacial Orthopedics CA 45367