Organization
TAVALLAEI, D.M.D., CORPORATION
Active
Other names
Make a Smile
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN CASTILLO (OPERATIONS MANAGER)
(916) 781-6550
Entity
Organization
Contact information
Practice address
9130 ALCOSTA BLVD STE A, SAN RAMON, CA 94583-3847
(925) 402-4141
(916) 983-9012
Mailing address
2260 E BIDWELL ST STE 310, FOLSOM, CA 95630-3555
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
1700020026
CA
Other
Enumeration date
12/06/2017
Last updated
08/10/2022
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