Provider Demographics
NPI:1881892966
Name:ALISO NIGUEL DENTAL GROUP
Entity type:Organization
Organization Name:ALISO NIGUEL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-292-2733
Mailing Address - Street 1:24541 PACIFIC PARK DR
Mailing Address - Street 2:STE 105
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656
Mailing Address - Country:US
Mailing Address - Phone:949-643-7047
Mailing Address - Fax:949-643-7049
Practice Address - Street 1:24541 PACIFIC PARK DR
Practice Address - Street 2:STE 105
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656
Practice Address - Country:US
Practice Address - Phone:949-643-7047
Practice Address - Fax:949-643-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47417122300000X
CA52373122300000X
CA033687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty