MEDICARE: DENTERACTIVE SOLUTIONS 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	122300000X	Dentist

General Provider Information

NPI Number	:	1265187975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTERACTIVE SOLUTIONS INC.

Provider Business Mailing Address
First Line	:	23 CORPORATE PLAZA DR STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7908
Country	:	US
Telephone Number	:	888-574-7754
Fax Number	:

Provider Business Practice Location Address
First Line	:	22982 EL TORO RD STE 100
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-4919
Country	:	US
Telephone Number	:	949-305-0202
Fax Number	:	949-305-0203

Authorized Official
Title or Position	:	CEO
Name	:	DR. REZA IZADI
Credential	:	DDS
Telephone Number	:	949-290-6950

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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Directions to “DENTERACTIVE SOLUTIONS INC. ” Practice Location

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