Individual
DR. ALIREZA BASTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
24896 CHRISANTA DR STE 120, MISSION VIEJO, CA 92691-4800
(949) 347-0780
(949) 347-9549
Mailing address
24896 CHRISANTA DR STE 120, MISSION VIEJO, CA 92691-4800
(949) 347-0780
(949) 347-9549
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
49841
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49841
CA DENTAL LICENSE
CA
01
—
770633750
CORPORATION TAX ID
CA
Enumeration date
11/17/2006
Last updated
08/06/2024
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