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General NPI Number Information
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NPI Number | 1629408430
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Entity Type | Organization
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Legal Business Name | H. BOTSHEKAN D.D.S
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Dates
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Enumeration Date | 11/14/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 23823 EL TORO RD. SUTE E-122 EL TORO DENTAL CARE
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City | LAKE FOREST
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State | CA
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Zip | 92630
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Country | US
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Telephone | 949-855-9212
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Fax | 949-855-9272
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Provider Business Mailing Address
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Address Line | 23823 EL TORO RD. SUTE E-122 EL TORO DENTAL CARE
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City | LAKE FOREST
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State | CA
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Zip | 92630
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Country | US
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Telephone | 949-855-9212
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Fax | 949-855-9272
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. HOLLY BOTSHEKAN
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Credential | D.D.S.
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Telephone | 480-221-6475
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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 | 55171, DENTIST
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License Number State | CA
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