Provider Demographics
NPI:1588445241
Name:OMID DIANAT, DDS, MS, PC
Entity type:Organization
Organization Name:OMID DIANAT, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEYED OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:DIANAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:949-527-8377
Mailing Address - Street 1:235 BRYCE RUN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8732
Mailing Address - Country:US
Mailing Address - Phone:949-527-8377
Mailing Address - Fax:
Practice Address - Street 1:22 ODYSSEY STE 125
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3193
Practice Address - Country:US
Practice Address - Phone:949-622-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental