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General NPI Number Information
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NPI Number | 1124509989
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Entity Type | Organization
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Legal Business Name | MIKAEYA KALANTARI DENTAL CORPORATION
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 27725 SANTA MARGARITA PKWY STE 270
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6708
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Country | US
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Telephone | 949-951-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 27725 SANTA MARGARITA PKWY STE 270
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6708
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Country | US
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Telephone | 949-951-0951
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIKAEYA KALANTARI
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Credential | DDS
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Telephone | 913-669-8219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | CA
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