Healthcare Provider Details

I. General information

NPI: 1235477308
Provider Name (Legal Business Name): S VESHKINI ORTHODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26902 OSO PKWY SUITE #100
MISSION VIEJO CA
92691-5801
US

IV. Provider business mailing address

26902 OSO PKWY SUITE #100
MISSION VIEJO CA
92691-5801
US

V. Phone/Fax

Practice location:
  • Phone: 949-855-2060
  • Fax: 949-582-1837
Mailing address:
  • Phone: 949-855-2060
  • Fax: 949-582-1837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36026
License Number StateCA

VIII. Authorized Official

Name: SIAMAK VESHKINI
Title or Position: OWNER
Credential: D.M.D.
Phone: 949-855-2060