Provider Demographics
NPI:1548653249
Name:KALANTARI DDS DENTAL CORPORATION
Entity type:Organization
Organization Name:KALANTARI DDS DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEI KALANTARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-662-2000
Mailing Address - Street 1:2502 S BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5725
Mailing Address - Country:US
Mailing Address - Phone:714-662-2000
Mailing Address - Fax:
Practice Address - Street 1:2502 S BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5725
Practice Address - Country:US
Practice Address - Phone:714-662-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty