| Mission Dental Implant Center | |
|
24953 Paseo De Valencia Ste 13c Laguna Hills CA 92653-4344 | |
| (949) 600-7123 | |
| (949) 364-2870 |
| Full Name | Mission Dental Implant Center |
|---|---|
| Speciality | Dentist |
| Location | 24953 Paseo De Valencia Ste 13c, Laguna Hills, California |
| Authorized Official Name and Position | Al Shyste Manesh (OWNER) |
| Authorized Official Contact | 9493642935 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission Dental Implant Center 26800 Crown Valley Pkwy Suite 425 Mission Viejo CA 92691-6384 Ph: (949) 364-2935 | Mission Dental Implant Center 24953 Paseo De Valencia Ste 13c Laguna Hills CA 92653-4344 Ph: (949) 600-7123 |
| NPI Number | 1184888398 |
|---|---|
| Provider Enumeration Date | 07/16/2008 |
| Last Update Date | 11/24/2020 |
| Medicare PECOS PAC ID | 7719120740 |
|---|---|
| Medicare Enrollment ID | O20130823000551 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184888398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 48376 (California) | Secondary |
| 1223P0300X | Dentist - Periodontics | 48376 (California) | Primary |
| Provider Name | Al Shyste Manesh |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1124241575 PECOS PAC ID: 8628211653 Enrollment ID: I20130823000573 |
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