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General NPI Number Information
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NPI Number | 1518325117
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Entity Type | Organization
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Legal Business Name | CIMA MAZAR-ATABAKI DMD INC
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 03/04/2016
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Provider Practice Location Address
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Address Line | 24541 PACIFIC PARK DR SUITE #104
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3065
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Country | US
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Telephone | 310-985-0418
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Fax |
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Provider Business Mailing Address
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Address Line | 24541 PACIFIC PARK DR SUITE #104
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3065
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Country | US
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Telephone | 310-985-0418
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | DR. CIMA MAZAR-ATABAKI
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Credential | DMD
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Telephone | 310-985-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 58241
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License Number State | CA
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