MEDICARE: ASEMI DDS A PROFESSIONAL DENTAL CORPORATION

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
2	122300000X	Dentist

General Provider Information

NPI Number	:	1306684279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASEMI DDS A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	915 S CATALINA AVE STE A
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	650-274-6832
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S CATALINA AVE STE A
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-4795
Country	:	US
Telephone Number	:	650-274-6832
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. ARIA ASEMI
Credential	:	DDS
Telephone Number	:	650-274-6832

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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