Provider Demographics
NPI:1841405065
Name:SERENE DENTAL CENTER
Entity Type:Organization
Organization Name:SERENE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PERSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:SHERY
Authorized Official - Last Name:MANSOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-748-7373
Mailing Address - Street 1:2500 ALTON PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5024
Mailing Address - Country:US
Mailing Address - Phone:949-748-7373
Mailing Address - Fax:949-748-7375
Practice Address - Street 1:2500 ALTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5024
Practice Address - Country:US
Practice Address - Phone:949-748-7373
Practice Address - Fax:949-748-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53648122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty