| Edalat DDS Inc. | |
|
130 Avenida Cabrillo Ste B San Clemente CA 92672-5509 | |
| (949) 409-4080 | |
| (949) 284-9200 |
| Full Name | Edalat DDS Inc. |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 130 Avenida Cabrillo Ste B, San Clemente, California |
| Authorized Official Name and Position | Hossein Edalat (ENDODONTIST-OWNER) |
| Authorized Official Contact | 3109998777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edalat DDS Inc. 18625 Brookhurst St Fountain Valley CA 92708-6748 Ph: (949) 409-4080 | Edalat DDS Inc. 130 Avenida Cabrillo Ste B San Clemente CA 92672-5509 Ph: (949) 409-4080 |
| NPI Number | 1013577071 |
|---|---|
| Provider Enumeration Date | 06/20/2019 |
| Last Update Date | 08/30/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013577071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | (NU) | Primary |
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