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General NPI Number Information
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NPI Number | 1245310119
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Entity Type | Organization
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Legal Business Name | DJAFARI, D.D.S., INC.
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 6900 BROCKTON AVE STE 2
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City | RIVERSIDE
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State | CA
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Zip | 92506-3801
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Country | US
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Telephone | 951-682-2245
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Fax | 951-628-9169
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Provider Business Mailing Address
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Address Line | 6900 BROCKTON AVE STE 2
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City | RIVERSIDE
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State | CA
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Zip | 92506-3801
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Country | US
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Telephone | 951-682-2245
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Fax | 951-628-9169
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. PARISSA DJAFARI
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Credential | D.D.S.
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Telephone | 951-682-2245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44308
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License Number State | CA
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