| South Coast Dental Specalists | |
|
1503 S Coast Dr Costa Mesa CA 92626-1534 | |
| (714) 662-4424 | |
| Not Available |
| Full Name | South Coast Dental Specalists |
|---|---|
| Speciality | Dentist |
| Location | 1503 S Coast Dr, Costa Mesa, California |
| Authorized Official Name and Position | Massoud Kashanchi (DENTIST) |
| Authorized Official Contact | 7146624424 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Dental Specalists 1503 S. Coast Dr. 110 Costa Mesa CA 92626 Ph: (714) 662-4424 | South Coast Dental Specalists 1503 S Coast Dr Costa Mesa CA 92626-1534 Ph: (714) 662-4424 |
| NPI Number | 1972013134 |
|---|---|
| Provider Enumeration Date | 10/02/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3971915125 |
|---|---|
| Medicare Enrollment ID | O20201214000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972013134 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | 30399 (California) | Primary |
| Provider Name | Sam Gilani |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1134179443 PECOS PAC ID: 7911065495 Enrollment ID: I20081028000420 |
| Provider Name | Massoud Kashanchi |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1245459379 PECOS PAC ID: 4880006030 Enrollment ID: I20201214000733 |
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