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General NPI Number Information
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NPI Number | 1407196587
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Entity Type | Organization
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Legal Business Name | MEHRDOKHT MEHRVARZI DENTAL CORP.
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Dates
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Enumeration Date | 02/26/2013
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 31952 CAMINO CAPISTRANO STE C14&C16
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3229
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Country | US
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Telephone | 949-240-6888
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Fax | 949-240-7653
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Provider Business Mailing Address
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Address Line | 31952 CAMINO CAPISTRANO STE C14&C16
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3229
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Country | US
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Telephone | 949-240-6888
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Fax | 949-240-7653
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MEHRDOKHT MEHRVARZI
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Credential | DDS
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Telephone | 949-240-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 39184
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License Number State | CA
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