Provider Demographics
NPI:1114630449
Name:MAHASTY MAHOOTY RDHAP HEALTHY SMILES OF CALIFORNIA DENTAL HYGIENE, INC
Entity Type:Organization
Organization Name:MAHASTY MAHOOTY RDHAP HEALTHY SMILES OF CALIFORNIA DENTAL HYGIENE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHASTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHOOTY
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:949-291-7078
Mailing Address - Street 1:2721 2ND ST APT 221
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4140
Mailing Address - Country:US
Mailing Address - Phone:949-291-7078
Mailing Address - Fax:
Practice Address - Street 1:2721 2ND ST APT 221
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4140
Practice Address - Country:US
Practice Address - Phone:949-291-7078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty