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General NPI Number Information
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NPI Number | 1730364662
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Entity Type | Organization
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Legal Business Name | EL PASEO DENTAL INC.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 22195 EL PASEO SUITE 260
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3951
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Country | US
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Telephone | 949-459-9300
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Fax | 949-459-2031
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Provider Business Mailing Address
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Address Line | 22195 EL PASEO #260
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3951
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Country | US
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Telephone | 949-459-9300
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Fax | 949-459-2013
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Authorized Official
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Title or Position | DENTIST
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Name | DR. AMIR LARIJANI
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Credential | D.D.S.
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Telephone | 949-459-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 46854
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License Number State | CA
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