=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275006959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHAR YAFTALY DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2019
-----------------------------------------------------
Last Update Date | 01/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2045 ROYAL AVE STE 109
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-522-9242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2045 ROYAL AVE STE 109
-----------------------------------------------------
City | SIMI VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93065-4666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAHAR YAFTALY
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 805-522-9242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------