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General NPI Number Information
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NPI Number | 1710859046
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Entity Type | Organization
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Legal Business Name | P KERMANSHAHI MONFARED A DENTAL CORP
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 23642 ROCKFIELD BLVD STE 503
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City | LAKE FOREST
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State | CA
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Zip | 92630-1681
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Country | US
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Telephone | 949-317-3367
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Fax |
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Provider Business Mailing Address
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Address Line | 23642 ROCKFIELD BLVD STE 503
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City | LAKE FOREST
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State | CA
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Zip | 92630-1681
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Country | US
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Telephone | 949-317-3367
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. PARISA KERMANSHAHI MONFARED
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Credential | DMD
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Telephone | 702-403-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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