Provider Demographics
NPI:1902099112
Name:HEDIEH TAVAJOHI-KERMANI, DDS, MDS, INC
Entity Type:Organization
Organization Name:HEDIEH TAVAJOHI-KERMANI, DDS, MDS, INC
Other - Org Name:NEWPORT ORTHODONTICS & CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEDI
Authorized Official - Middle Name:
Authorized Official - Last Name:KERMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:949-836-1699
Mailing Address - Street 1:2549 EASTBLUFF DR STE B
Mailing Address - Street 2:#415
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3500
Mailing Address - Country:US
Mailing Address - Phone:949-640-5050
Mailing Address - Fax:949-640-5051
Practice Address - Street 1:2515 EASTBLUFF DR.
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-640-5050
Practice Address - Fax:949-640-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty