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General NPI Number Information
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NPI Number | 1871084400
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Entity Type | Organization
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Legal Business Name | SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 245 N GLASSELL ST STE A
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City | ORANGE
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State | CA
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Zip | 92866-1408
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Country | US
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Telephone | 714-532-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 930 S HARVARD CIR
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City | ANAHEIM
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State | CA
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Zip | 92807-5021
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Country | US
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Telephone | 714-423-1470
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST, CEO
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Name | SHEFAGH SHERRY DARABI
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Credential | DDS
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Telephone | 714-423-1470
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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 | 59923
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License Number State | CA
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