Provider Demographics
NPI:1679182869
Name:ABRISHAMI BASTI DENTAL CORPORATION
Entity Type:Organization
Organization Name:ABRISHAMI BASTI DENTAL CORPORATION
Other - Org Name:TLC FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPIDEH
Authorized Official - Middle Name:ABRISHAMI
Authorized Official - Last Name:BASTI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-897-8980
Mailing Address - Street 1:6552 BOLSA AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2656
Mailing Address - Country:US
Mailing Address - Phone:714-897-8980
Mailing Address - Fax:
Practice Address - Street 1:6552 BOLSA AVE STE Q
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2656
Practice Address - Country:US
Practice Address - Phone:714-897-8980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty