Provider Demographics
NPI:1902138886
Name:ALI MANOUCHEHRI DDS APC
Entity Type:Organization
Organization Name:ALI MANOUCHEHRI DDS APC
Other - Org Name:TRI-CITY CHILDREN'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUCHEHRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-724-1102
Mailing Address - Street 1:31 CUERVO DR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3230 WARING CT
Practice Address - Street 2:SUITE Q
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-724-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty