Shahin Mahallati Dental Corp
Dentist, General Practice in San Clemente, CA. Organization (NPI-2).
NPI number1962043919
StatusActive
Last updated in NPPESNov 10, 2021
Details
- NPI
- 1962043919
- Entity type
- Organization (NPI-2)
- Legal business name
- Shahin Mahallati Dental Corp
- Organization subpart
- No
- Enumeration date
- Oct 1, 2019
- Certification date
- Nov 10, 2021
- Last updated
- Nov 10, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Smile San Clemente (Doing Business As)
Practice location
653 Camino De Los Mares Ste 113San Clemente, CA 92673-2856
Phone 949-248-7772
Mailing address
653 Camino De Los Mares Ste 113San Clemente, CA 92673-2856
Phone 949-248-7772 · Fax 949-248-0516
Authorized official
Shahin Mahallati
Owner
9492487772
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