Basic Information
| Provider Information | |||||||||
| NPI: | 1316508674 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABDESHAHIAN AND NGUYEN DENTAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | STANTON SMILES DENTISTRY DENTAL GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 920050 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753920050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148458500 | ||||||||
| FaxNumber: | 3039520892 | ||||||||
| Practice Location | |||||||||
| Address1: | 12919 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | STANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906804001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147712982 | ||||||||
| FaxNumber: | 7149074409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2019 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| AuthorizedOfficialLastName: | ABDESHAHIAN | ||||||||
| AuthorizedOfficialFirstName: | IMAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | GP/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7147712982 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DMD | ||||||||
| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.