Healthcare Provider Details

I. General information

NPI: 1710859046
Provider Name (Legal Business Name): P KERMANSHAHI MONFARED A DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23642 ROCKFIELD BLVD STE 503
LAKE FOREST CA
92630-1681
US

IV. Provider business mailing address

23642 ROCKFIELD BLVD STE 503
LAKE FOREST CA
92630-1681
US

V. Phone/Fax

Practice location:
  • Phone: 949-317-3367
  • Fax:
Mailing address:
  • Phone: 949-317-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PARISA KERMANSHAHI MONFARED
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 702-403-9015