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General NPI Number Information
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NPI Number | 1285215996
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Entity Type | Organization
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Legal Business Name | OFFICE OF SHAHGALDIAN DENTAL CORP
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 5275 HOLT BLVD. SUITE E
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City | MONTCLAIR
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State | CA
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Zip | 91763-9120
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Country | US
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Telephone | 818-523-7626
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Fax |
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Provider Business Mailing Address
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Address Line | 5275 HOLT BLVD SUITE E
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City | MONTCLAIR
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State | CA
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Zip | 91763
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Country | US
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Telephone | 818-523-7626
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Fax |
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Authorized Official
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Title or Position | DENTIST/ OWNER
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Name | CHRISTINE SHAHGALDIAN
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Credential |
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Telephone | 818-523-7626
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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 |
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License Number State |
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