Organization
TAVALLAEI DMD CORP
Active
Other names
Make a Smile
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN CASTILLO (ADMIN)
(916) 781-6550
Entity
Organization
Contact information
Practice address
5756 PACIFIC AVE STE 75A, STOCKTON, CA 95207-5156
(916) 984-0304
Mailing address
400 PLAZA DR # 120-319, FOLSOM, CA 95630-4744
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/20/2024
Last updated
06/20/2024
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