MEDICARE: KATAYOUN SETAREH 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1467693382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATAYOUN SETAREH DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 920050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0050
Country	:	US
Telephone Number	:	714-368-2077
Fax Number	:	714-368-2092

Provider Business Practice Location Address
First Line	:	2650 TAPO CANYON RD
Second Line	:	SUITE 107
City	:	SIMI VALLEY
State	:	CA
Zip	:	93063-2308
Country	:	US
Telephone Number	:	805-522-5516
Fax Number	:	805-578-9079

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	DR. KATAYOUN SETAREH
Credential	:	DDS
Telephone Number	:	805-522-5516

Provider Enumeration Date	:	03/23/2009
Last Update Date	:	08/05/2022

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