Provider Demographics
NPI:1609188994
Name:KALANTARI, MIKAEYA (DDS)
Entity Type:Individual
Prefix:
First Name:MIKAEYA
Middle Name:
Last Name:KALANTARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27725 SANTA MARGARITA PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6708
Mailing Address - Country:US
Mailing Address - Phone:949-951-0951
Mailing Address - Fax:949-652-3445
Practice Address - Street 1:27725 SANTA MARGARITA PKWY STE 270
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6708
Practice Address - Country:US
Practice Address - Phone:949-951-0951
Practice Address - Fax:949-652-3445
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100161381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry