Organization
THE SAFOURA MASSOURI PROFESSIONAL DENTAL CORP
Active
Other names
Childrens Primary Dental Care & Adult Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
SAFOURA MASSOUMI D.D.S. (OWNER)
(619) 425-9930
Entity
Organization
Contact information
Practice address
397 E ST, STE #A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Mailing address
397 E ST, STE #A, CHULA VISTA, CA 91910
(619) 425-9930
(619) 425-9887
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
40677
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9226501
—
CA
Enumeration date
02/12/2007
Last updated
05/15/2015
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