Provider Demographics
NPI:1831440502
Name:AGHALOO, DDS, INC.
Entity type:Organization
Organization Name:AGHALOO, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINA
Authorized Official - Prefix:
Authorized Official - First Name:TATUM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAPPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-343-7737
Mailing Address - Street 1:39620 WASHINGTON ST. SUITE C
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-343-7737
Mailing Address - Fax:760-343-7682
Practice Address - Street 1:39620 WASHINGTON ST. SUITE C
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-343-7737
Practice Address - Fax:760-343-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty