Provider Demographics
NPI:1649549130
Name:REZAEI KALANTARI, DANIAL
Entity type:Individual
Prefix:DR
First Name:DANIAL
Middle Name:
Last Name:REZAEI KALANTARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 ALISO DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7616
Mailing Address - Country:US
Mailing Address - Phone:916-718-6655
Mailing Address - Fax:
Practice Address - Street 1:3714 ALISO DR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-7616
Practice Address - Country:US
Practice Address - Phone:916-718-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist