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General NPI Number Information
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NPI Number | 1407267974
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Entity Type | Organization
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Legal Business Name | NIKTASH DENTAL CORPORATION
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 31726 RANCHO VIEJO RD SUITE 109
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2779
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Country | US
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Telephone | 949-481-1212
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Fax | 949-258-9822
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Provider Business Mailing Address
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Address Line | 31726 RANCHO VIEJO RD STE B-109
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2779
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Country | US
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Telephone | 949-481-2121
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Fax | 949-218-7556
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MOJGAN NIKTASH
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Credential | D.D.S.
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Telephone | 949-481-2121
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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 | 45598
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License Number State | CA
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