Provider Demographics
NPI:1548895634
Name:MOMANI DDS INC
Entity type:Organization
Organization Name:MOMANI DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-527-3990
Mailing Address - Street 1:3025 MCHENRY AVE.
Mailing Address - Street 2:STE N
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1449
Mailing Address - Country:US
Mailing Address - Phone:209-337-4777
Mailing Address - Fax:209-236-4464
Practice Address - Street 1:600 W I ST.
Practice Address - Street 2:STE B
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3460
Practice Address - Country:US
Practice Address - Phone:209-675-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOMANI DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental