Provider Demographics
NPI:1144210105
Name:MAHALLATI DENTAL CORPORATION
Entity Type:Organization
Organization Name:MAHALLATI DENTAL CORPORATION
Other - Org Name:BAY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:HASHEMBEIK
Authorized Official - Last Name:MAHALLATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-540-2836
Mailing Address - Street 1:3620 S BRISTOL ST
Mailing Address - Street 2:SUITE #307
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7300
Mailing Address - Country:US
Mailing Address - Phone:714-540-2836
Mailing Address - Fax:714-540-4986
Practice Address - Street 1:3620 S BRISTOL ST
Practice Address - Street 2:SUITE #307
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7300
Practice Address - Country:US
Practice Address - Phone:714-540-2836
Practice Address - Fax:714-540-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty