| Tavallaei DMD Corp | |
|
4363 Golden Center Dr # A Placerville CA 95667-6260 | |
| (916) 984-0304 | |
| Not Available |
| Full Name | Tavallaei DMD Corp |
|---|---|
| Speciality | Dentist |
| Location | 4363 Golden Center Dr # A, Placerville, California |
| Authorized Official Name and Position | Megan Castillo (BUSINESS MANAGER) |
| Authorized Official Contact | 9167816550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tavallaei DMD Corp 2260 E Bidwell St # 316 Folsom CA 95630-3555 | Tavallaei DMD Corp 4363 Golden Center Dr # A Placerville CA 95667-6260 Ph: (916) 984-0304 |
| NPI Number | 1013623586 |
|---|---|
| Provider Enumeration Date | 01/26/2023 |
| Last Update Date | 01/26/2023 |
| Certification Date | 01/26/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013623586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (NU) | Primary |
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