Provider Demographics
NPI:1689049892
Name:DANDONE
Entity Type:Organization
Organization Name:DANDONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SOUDABEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARAFI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-259-5527
Mailing Address - Street 1:3525 DEL MAR HEIGHTS RD
Mailing Address - Street 2:SUITE 830
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2199
Mailing Address - Country:US
Mailing Address - Phone:760-291-1700
Mailing Address - Fax:
Practice Address - Street 1:3525 DEL MAR HEIGHTS RD
Practice Address - Street 2:SUITE 830
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2199
Practice Address - Country:US
Practice Address - Phone:858-259-5527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52929122300000X, 1223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty