Provider Demographics
NPI:1942448865
Name:ARDJMAND, HOMAYOUN (DDS)
Entity type:Individual
Prefix:DR
First Name:HOMAYOUN
Middle Name:
Last Name:ARDJMAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 MAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2150
Mailing Address - Country:US
Mailing Address - Phone:619-443-8447
Mailing Address - Fax:619-443-5450
Practice Address - Street 1:9280 MAST BLVD
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2150
Practice Address - Country:US
Practice Address - Phone:619-443-8447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39129122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD39129OtherDENTI-CAL