Provider Demographics
NPI:1144266420
Name:AHMADI, TANNAZ (DDS)
Entity type:Individual
Prefix:DR
First Name:TANNAZ
Middle Name:
Last Name:AHMADI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 DELBON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2022
Mailing Address - Country:US
Mailing Address - Phone:209-664-2000
Mailing Address - Fax:
Practice Address - Street 1:800 DELBON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-5482
Practice Address - Country:US
Practice Address - Phone:209-345-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA518901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7177760001Medicare NSC