Healthcare Provider Details

I. General information

NPI: 1942868054
Provider Name (Legal Business Name): HAERI PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 SANTA MARGARITA PKWY STE 242
MISSION VIEJO CA
92691-6708
US

IV. Provider business mailing address

27758 SANTA MARGARITA PKWY # 382
MISSION VIEJO CA
92691-6709
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMTIN KHAEF
Title or Position: OWNER
Credential: DMD
Phone: 949-510-0225