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NPI Code Detail

MEDICARE: SHAHRESTANI DEER SPRINGS MODERN DENTISTRY, PC

MEDICARE: SHAHRESTANI DEER SPRINGS MODERN DENTISTRY, 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
1122300000XDentist

General Provider Information

NPI Number : 1922351931
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAHRESTANI DEER SPRINGS MODERN DENTISTRY, 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 : 640 E DEER SPRINGS WAY STE 180
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89086-1514
Country : US
Telephone Number : 702-399-3800
Fax Number : 702-399-3801
Authorized Official
Title or Position : OWNER DOCTOR
Name : DR. ALI SHAHRESTANI
Credential : DMD
Telephone Number : 702-399-3800
Provider Enumeration Date : 10/16/2012
Last Update Date : 01/03/2014

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