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General NPI Number Information
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NPI Number | 1760974182
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Entity Type | Organization
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Legal Business Name | DR MAGHIRAN DENTAL CORP
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/01/2018
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Provider Practice Location Address
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Address Line | 11819 FOOTHILL BLVD STE G
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3939
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Country | US
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Telephone | 818-486-8093
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Fax |
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Provider Business Mailing Address
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Address Line | 11819 FOOTHILL BLVD STE G
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3939
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Country | US
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Telephone | 818-486-8093
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | GANI MAGHIRAN
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Credential | OFFICE MANAGER
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Telephone | 818-486-8093
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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 | 44029
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License Number State | CA
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