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653 Camino De Los Mares Ste 113 San Clemente CA 92673-2856 | |
| (949) 248-7772 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 653 Camino De Los Mares Ste 113, San Clemente, California |
| Authorized Official Name and Position | Shahin Mahallati (OWNER) |
| Authorized Official Contact | 9492487772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
653 Camino De Los Mares Ste 113 San Clemente CA 92673-2856 Ph: (949) 248-7772 | 653 Camino De Los Mares Ste 113 San Clemente CA 92673-2856 Ph: (949) 248-7772 |
| NPI Number | 1962043919 |
|---|---|
| Provider Enumeration Date | 10/01/2019 |
| Last Update Date | 11/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962043919 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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