# EDALAT DDS INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013577071
- **Authorized official:** DR. HOSSEIN EDALAT DDS (ENDODONTIST-OWNER)
- **Authorized official phone:** (310) 999-8777

## Contact information

- **Practice address:** 130 AVENIDA CABRILLO STE B, SAN CLEMENTE, CA 92672-5509
- **Practice address phone:** (949) 409-4080
- **Practice address fax:** (949) 284-9200
- **Mailing address:** 18625 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-6748
- **Mailing address phone:** (949) 409-4080
- **Mailing address fax:** (949) 284-9200

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 06/20/2019
- **Last updated:** 08/30/2019