| Tavallaei, D.m.d., Corporation | |
|
4060 Douglas Blvd Ste 110 Granite Bay CA 95746-5934 | |
| (916) 260-0646 | |
| Not Available |
| Full Name | Tavallaei, D.m.d., Corporation |
|---|---|
| Speciality | Dentist |
| Location | 4060 Douglas Blvd Ste 110, Granite Bay, California |
| Authorized Official Name and Position | Megan Castillo (OPERATIONS MANAGER) |
| Authorized Official Contact | 9167816550 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tavallaei, D.m.d., Corporation 2260 E Bidwell St # 313 Folsom CA 95630-3555 Ph: () - | Tavallaei, D.m.d., Corporation 4060 Douglas Blvd Ste 110 Granite Bay CA 95746-5934 Ph: (916) 260-0646 |
| NPI Number | 1134716939 |
|---|---|
| Provider Enumeration Date | 12/28/2020 |
| Last Update Date | 08/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134716939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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