Healthcare Provider Details

I. General information

NPI: 1699202531
Provider Name (Legal Business Name): ZAERY KALANTARI DENTAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27725 SANTA MARGARITA PKWY STE 270
MISSION VIEJO CA
92691
US

IV. Provider business mailing address

27725 SANTA MARGARITA PKWY STE 270
MISSION VIEJO CA
92691-6708
US

V. Phone/Fax

Practice location:
  • Phone: 949-951-0951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60059
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number60449
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number65087
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53362
License Number StateCA

VIII. Authorized Official

Name: DR. FARRAH ZAERY
Title or Position: PRESIDENT/MANAGING PARTNER
Credential: DDS
Phone: 913-486-7641