Provider Demographics
NPI:1558891481
Name:DADSERESHT DDS INC
Entity Type:Organization
Organization Name:DADSERESHT DDS INC
Other - Org Name:CHOICE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DADSERESHT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-592-1989
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD STE 126
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5211
Mailing Address - Country:US
Mailing Address - Phone:951-676-4556
Mailing Address - Fax:
Practice Address - Street 1:29645 RANCHO CALIFORNIA RD STE 126
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5211
Practice Address - Country:US
Practice Address - Phone:951-676-4556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA410721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty