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General NPI Number Information
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NPI Number | 1114630449
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Entity Type | Organization
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Legal Business Name | MAHASTY MAHOOTY RDHAP HEALTHY SMILES OF CALIFORNIA DENTAL HYGIENE, INC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/02/2023
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Provider Practice Location Address
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Address Line | 2721 2ND ST APT 221
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City | SANTA MONICA
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State | CA
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Zip | 90405-4140
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Country | US
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Telephone | 949-291-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 2721 2ND ST APT 221
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City | SANTA MONICA
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State | CA
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Zip | 90405-4140
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Country | US
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Telephone | 949-291-7078
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAHASTY MAHOOTY
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Credential | RDHAP
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Telephone | 949-291-7078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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