Healthcare Provider Details

I. General information

NPI: 1700710092
Provider Name (Legal Business Name): BRENTWOOD HILLS MODERN DENTISTRY, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 SAND CREEK RD STE E6
BRENTWOOD CA
94513-7242
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 925-718-7121
  • Fax: 925-418-0053
Mailing address:
  • Phone: 714-845-8890
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAHAR TAHA
Title or Position: OWNER
Credential: DDS
Phone: 925-718-7121