Provider Demographics
NPI:1265187975
Name:DENTERACTIVE SOLUTIONS INC.
Entity type:Organization
Organization Name:DENTERACTIVE SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-290-6950
Mailing Address - Street 1:23 CORPORATE PLAZA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7908
Mailing Address - Country:US
Mailing Address - Phone:888-574-7754
Mailing Address - Fax:
Practice Address - Street 1:22982 EL TORO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-4919
Practice Address - Country:US
Practice Address - Phone:949-305-0202
Practice Address - Fax:949-305-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty