# SHAHRESTANI SPARKS MARINA DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sparks Marina Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760861447
- **Authorized official:** ALI SHAHRESTANI CYNTHIA CASTILLO (CREDENTIALING ADMINISTRATOR)
- **Authorized official phone:** (714) 845-8704

## Contact information

- **Practice address:** 475 SPARKS BLVD, SUITE 101, SPARKS, NV 89434-9002
- **Practice address phone:** (775) 359-1565
- **Practice address fax:** (775) 359-1597
- **Mailing address:** 17000 RED HILL AVE, IRVINE, CA 92614-5626
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (949) 474-1495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/27/2015
- **Last updated:** 05/27/2015