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General NPI Number Information
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NPI Number | 1356625537
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Entity Type | Organization
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Legal Business Name | SHAHIN MAHALLATI DDS INC
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1319 N MAIN ST
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City | SANTA ANA
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State | CA
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Zip | 92701-2318
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Country | US
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Telephone | 714-972-2782
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 S BRISTOL ST SUITE 307
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City | SANTA ANA
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State | CA
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Zip | 92704-7300
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Country | US
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Telephone | 714-540-2836
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Fax | 714-540-4986
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SHAHIN MAHALLATI
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Credential | DDS
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Telephone | 714-640-2836
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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 | 43194
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License Number State | CA
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