MEDICARE: DENTISTS OF GAINESVILLE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1023546611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTISTS OF GAINESVILLE, PC

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	949-474-1495

Provider Business Practice Location Address
First Line	:	8140 STONEWALL SHOPS SQUARE
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155
Country	:	US
Telephone Number	:	571-298-8279
Fax Number	:	571-366-4697

Authorized Official
Title or Position	:	DDS/OWNER
Name	:	ALI SHAHRESTANI
Credential	:
Telephone Number	:	571-298-8279

Provider Enumeration Date	:	05/26/2017
Last Update Date	:	05/26/2017

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