Provider Demographics
NPI:1326462730
Name:ROYA NEMATOLLAHI D.D.S. INC
Entity Type:Organization
Organization Name:ROYA NEMATOLLAHI D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATOLLAHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-544-8338
Mailing Address - Street 1:14122 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-5834
Mailing Address - Country:US
Mailing Address - Phone:714-544-8338
Mailing Address - Fax:714-573-1062
Practice Address - Street 1:14122 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-5834
Practice Address - Country:US
Practice Address - Phone:714-544-8338
Practice Address - Fax:714-573-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty