Healthcare Provider Details

I. General information

NPI: 1285640045
Provider Name (Legal Business Name): ROYAL DENTAL AESTHETICS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W ROMNEYA DR
ANAHEIM CA
92801
US

IV. Provider business mailing address

1721 W ROMNEYA DR
ANAHEIM CA
92801
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-6400
  • Fax: 714-772-6440
Mailing address:
  • Phone: 714-772-6400
  • Fax: 714-772-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46879
License Number StateCA

VIII. Authorized Official

Name: MRS. FARAHNAZ MADANI
Title or Position: OWNER
Credential: DMD
Phone: 714-772-6400