Basic Information
| Provider Information | |||||||||
| NPI: | 1023200052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAHRESTANI | ||||||||
| FirstName: | ALI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2860 MICHELLE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926061009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145083600 | ||||||||
| FaxNumber: | 7143682092 | ||||||||
| Practice Location | |||||||||
| Address1: | 6525 N DECATUR BLVD STE 150 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891312993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025771941 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2007 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 0401415528 | VA | N | Dental Providers | Dentist | 1223G0001X | 16682 | MD | N | Dental Providers | Dentist | General Practice | 1223G0001X | 55849 | CA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 9043 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | 11318 | NC | N | Dental Providers | Dentist | General Practice | 1223G0001X | 0401415528 | VA | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 5554 | NV | N | Dental Providers | Dentist | General Practice |
No ID Information.