=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639508948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAHARI-RASHTI DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2013
-----------------------------------------------------
Last Update Date | 11/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 985 S SANTA FE AVE
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-940-8410
-----------------------------------------------------
Fax | 760-266-5204
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 985 S SANTA FE AVE
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-940-8410
-----------------------------------------------------
Fax | 760-266-5204
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HAMED SAHARI-RASHTI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 760-940-8410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 60248
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------