Basic Information
Provider Information
NPI: 1265763197
EntityType: 2
ReplacementNPI:  
OrganizationName: KATAYOUN AFSHAR AND AFSHIN HABASHI DENTAL CORPORATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: STONECREST DENTAL GROUP AND ORTHODONTICS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 17000 RED HILL AVE
Address2:  
City: IRVINE
State: CA
PostalCode: 926145626
CountryCode: US
TelephoneNumber: 7148458890
FaxNumber: 9494741495
Practice Location
Address1: 3737 MURPHY CANYON RD STE C-2
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921234454
CountryCode: US
TelephoneNumber: 8586940790
FaxNumber: 8583006527
Other Information
ProviderEnumerationDate: 01/15/2010
LastUpdateDate: 08/19/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KATAYOUN
AuthorizedOfficialFirstName: AFSHAR
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER/DOCTOR
AuthorizedOfficialTelephone: 8586940790
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DDS
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X  Y193200000X MULTI-SPECIALTY GROUPDental ProvidersDentistGeneral Practice

No ID Information.


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