Provider Demographics
NPI:1659764991
Name:SALLY KASHANI DDS, DENTAL CORPORATION
Entity Type:Organization
Organization Name:SALLY KASHANI DDS, DENTAL CORPORATION
Other - Org Name:TOLUCA LAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-508-7272
Mailing Address - Street 1:10719 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2312
Mailing Address - Country:US
Mailing Address - Phone:818-508-7272
Mailing Address - Fax:818-508-7444
Practice Address - Street 1:10719 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2312
Practice Address - Country:US
Practice Address - Phone:818-508-7272
Practice Address - Fax:818-508-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57454302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization