| |
30262 Crown Valley Pkwy Suite #e Laguna Niguel CA 92677-2364 | |
(949) 363-0018 | |
(949) 363-7295 |
Full Name | |
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Speciality | Dentist |
Location | 30262 Crown Valley Pkwy, Laguna Niguel, California |
Authorized Official Name and Position | Shahla Nadir Mohammadi (PRESIDENT) |
Authorized Official Contact | 6269757160 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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30262 Crown Valley Pkwy Laguna Niguel CA 92677-2364 Ph: (949) 363-0018 | 30262 Crown Valley Pkwy Suite #e Laguna Niguel CA 92677-2364 Ph: (949) 363-0018 |
NPI Number | 1972992618 |
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Provider Enumeration Date | 01/19/2015 |
Last Update Date | 01/19/2015 |
Identifier | Type | State | Issuer |
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1972992618 | NPI | - | NPPES |
44744 | Other | CA | LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 44744 (California) | Primary |
Balaze & Gregg Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 30131 Town Center Dr Ste 250, Laguna Niguel, CA 92677 Phone: 949-770-7686 | |
Glenn P. Frial, Dds, Ms, A Professional Corporation Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 28202 Cabot Rd, Suite 250, Laguna Niguel, CA 92677 Phone: 949-276-2105 Fax: 949-276-2109 |