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General NPI Number Information
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NPI Number | 1598013039
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Entity Type | Organization
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Legal Business Name | KHASATI & AWWAD DENTAL CORP.
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 33050 ANTELOPE RD SUITE 207
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City | MURRIETA
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State | CA
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Zip | 92562
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Country | US
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Telephone | 951-302-6222
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Fax | 951-302-2422
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Provider Business Mailing Address
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Address Line | 33050 ANTELOPE RD SUITE 207
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City | MURRIETA
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State | CA
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Zip | 92562
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Country | US
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Telephone | 951-302-6222
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Fax | 951-302-2422
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Authorized Official
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Title or Position | MANAGING DENTIST
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Name | SHADI K. KHASATI
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Credential | D.D.S.
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Telephone | 951-302-6222
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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 | 46741
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 504-78
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License Number State | CA
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