Provider Demographics
NPI:1285864223
Name:KATAYOUN MASSOUDI, DDS INCORPORATED
Entity Type:Organization
Organization Name:KATAYOUN MASSOUDI, DDS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:949-888-0086
Mailing Address - Street 1:30092 SANTA MARGARITA PKWY
Mailing Address - Street 2:STE. K
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3606
Mailing Address - Country:US
Mailing Address - Phone:949-888-0086
Mailing Address - Fax:949-888-0095
Practice Address - Street 1:30092 SANTA MARGARITA PKWY
Practice Address - Street 2:STE. K
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3606
Practice Address - Country:US
Practice Address - Phone:949-888-0086
Practice Address - Fax:949-888-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty