Organization
TAVALLAEI DMD CORP
Active
Other names
Make A Smile Children's Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MONICA TAVALLAEI (OWNER)
(916) 258-7639
Entity
Organization
Contact information
Practice address
731 STERLING PKWY, SUITE 100, LINCOLN, CA 95648-7306
(916) 258-7639
(916) 983-9012
Mailing address
2260 E BIDWELL ST, SUITE 310, FOLSOM, CA 95630-3463
(916) 258-7639
(916) 983-9012
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
48036
CA
Other
Enumeration date
07/18/2013
Last updated
08/04/2022
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