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 D.M.D (OWNER)
(916) 781-6550
Entity
Organization
Contact information
Practice address
2260 E BIDWELL ST, SUITE 305, FOLSOM, CA 95630-3463
(916) 380-0102
Mailing address
2241 SUNSET BLVD, SUITE D, ROCKLIN, CA 95765-4295
(916) 380-0102
(916) 983-9012
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
48036
CA
Other
Enumeration date
02/21/2014
Last updated
08/10/2022
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