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General NPI Number Information
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NPI Number | 1962649905
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Entity Type | Individual
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Provider Name | ELAHE ABTAHI DDS
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Gender | Female
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 1094 GLENNEYRE ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-2709
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Country | US
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Telephone | 949-497-6565
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Fax | 949-497-6555
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Provider Business Mailing Address
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Address Line | 1094 GLENNEYRE ST
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City | LAGUNA BEACH
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State | CA
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Zip | 92651
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Country | US
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Telephone | 949-497-6565
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Fax | 949-497-6555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 55342
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License Number State | CA
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