Provider Demographics
NPI:1972013134
Name:MASSOUD KASHANCHI, DDS. PROF. CORP.
Entity Type:Organization
Organization Name:MASSOUD KASHANCHI, DDS. PROF. CORP.
Other - Org Name:SOUTH COAST DENTAL SPECALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-662-4424
Mailing Address - Street 1:1503 S. COAST DR.
Mailing Address - Street 2:110
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-662-4424
Mailing Address - Fax:
Practice Address - Street 1:1503 S COAST DR
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1534
Practice Address - Country:US
Practice Address - Phone:714-662-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty