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General NPI Number Information
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NPI Number | 1215350467
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Entity Type | Organization
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Legal Business Name | REZA M. BIRJANDI D.D.S.,A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 15 MAREBLU SUITE 360
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City | ALISO VIEJO
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State | CA
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Zip | 92656
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Country | US
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Telephone | 949-360-9700
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Fax | 949-362-5182
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Provider Business Mailing Address
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Address Line | 27066 SOUTH LA PAZ ROAD
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3041
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Country | US
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Telephone | 949-360-9700
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Fax | 949-362-5182
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. ESBEIDY LOMELI
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Credential |
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Telephone | 951-323-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38259
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License Number State |
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