MEDICARE: SETAREHSHENAS DENTAL CORPORATION

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1821196213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SETAREHSHENAS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2860 MICHELLE
Second Line	:	2ND FLOOR
City	:	IRVINE
State	:	CA
Zip	:	92606-1009
Country	:	US
Telephone Number	:	714-508-3600
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	1197 E LOS ANGELES AVE
Second Line	:	STE. E
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2868
Country	:	US
Telephone Number	:	805-583-5700
Fax Number	:	805-583-5775

Authorized Official
Title or Position	:	OWNER DDS
Name	:	DR. KATAYOUN SETAREHSHENAS
Credential	:	DDS
Telephone Number	:	805-583-5700

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/03/2009

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