MEDICARE: S. SHAUN DANESHGAR DMD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1235607425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S. SHAUN DANESHGAR DMD INC

Provider Business Mailing Address
First Line	:	2771 E FLORENCE AVE STE E
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5750
Country	:	US
Telephone Number	:	310-701-0770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2771 E FLORENCE AVE STE E
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5750
Country	:	US
Telephone Number	:	310-701-0770
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MR. MICHAEL DANESHGAR
Credential	:
Telephone Number	:	310-701-0770

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	06/13/2019

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