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General NPI Number Information
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NPI Number | 1588283337
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Entity Type | Organization
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Legal Business Name | PRACTICE OF SHAHGALDIAN DENTAL INC.
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Dates
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Enumeration Date | 04/13/2020
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 407 E 1ST ST STE 2A
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City | SANTA ANA
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State | CA
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Zip | 92701-5340
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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 | 1526 EL RITO AVE
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City | GLENDALE
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State | CA
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Zip | 91208-1931
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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 | DR. 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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