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General NPI Number Information
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NPI Number | 1922612332
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Entity Type | Organization
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Legal Business Name | DIALANI DENTAL CORPORATION
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 2 JOURNEY STE 207
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3373
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Country | US
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Telephone | 949-702-2001
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Fax | 949-643-2226
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Provider Business Mailing Address
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Address Line | 27068 LA PAZ RD # 440
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3041
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Country | US
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Telephone | 949-702-2001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONI MOSHARAF
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Credential | DDS
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Telephone | 949-702-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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