Provider Demographics
NPI:1760294722
Name:INFINITE DENTAL ALLIANCE, INC
Entity type:Organization
Organization Name:INFINITE DENTAL ALLIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-809-3762
Mailing Address - Street 1:470 N LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1302
Mailing Address - Country:US
Mailing Address - Phone:626-325-6000
Mailing Address - Fax:626-598-3100
Practice Address - Street 1:470 N LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1302
Practice Address - Country:US
Practice Address - Phone:626-325-6000
Practice Address - Fax:626-598-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental