Elite Dental | |
18625 Brookhurst St Fountain Valley CA 92708-6748 | |
(714) 962-4486 | |
(714) 332-2979 |
Full Name | Elite Dental |
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Speciality | Clinic/Center |
Location | 18625 Brookhurst St, Fountain Valley, California |
Authorized Official Name and Position | Azadeh Ashtiany (OWNER) |
Authorized Official Contact | 7149624486 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Elite Dental 18625 Brookhurst St Fountain Valley CA 92708-6748 Ph: (714) 962-4486 | Elite Dental 18625 Brookhurst St Fountain Valley CA 92708-6748 Ph: (714) 962-4486 |
NPI Number | 1538723150 |
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Provider Enumeration Date | 04/29/2019 |
Last Update Date | 10/28/2019 |
Medicare PECOS PAC ID | 2567896632 |
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Medicare Enrollment ID | O20191224000056 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538723150 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Provider Name | Azadeh Ashtiany |
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Provider Type | Practitioner - Oral Surgery |
Provider Identifiers | NPI Number: 1639508278 PECOS PAC ID: 3476987546 Enrollment ID: I20200117000211 |
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