Healthcare Provider Details

I. General information

NPI: 1114630449
Provider Name (Legal Business Name): MAHASTY MAHOOTY RDHAP HEALTHY SMILES OF CALIFORNIA DENTAL HYGIENE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 2ND ST APT 221
SANTA MONICA CA
90405-4140
US

IV. Provider business mailing address

2721 2ND ST APT 221
SANTA MONICA CA
90405-4140
US

V. Phone/Fax

Practice location:
  • Phone: 949-291-7078
  • Fax:
Mailing address:
  • Phone: 949-291-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: MAHASTY MAHOOTY
Title or Position: PRESIDENT
Credential: RDHAP
Phone: 949-291-7078