Organization
ABOUSHETA DENTAL CORPORATION
Active
Other names
Irvine orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
TAREK ABOUSHETA DDS MSD (PRESIDENT)
(314) 853-5642
Entity
Organization
Contact information
Practice address
4482 BARRANCA PKWY STE 102, IRVINE, CA 92604-4744
(949) 786-7800
Mailing address
4482 BARRANCA PKWY STE 102, IRVINE, CA 92604-4744
(949) 786-7800
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659714194
NPI
CA
Enumeration date
05/15/2019
Last updated
06/11/2019
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