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Individual

ROSE DASTMALCHI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.D.S.

Contact information

Practice address
301 LENNON LN, SUITE 101, WALNUT CREEK, CA 94598-2483
(925) 937-2100
(925) 937-2100
Mailing address
301 LENNON LN, SUITE 101, WALNUT CREEK, CA 94598-2483
(925) 937-2100
(925) 937-2100

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
36910
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
036910
DELTA DENTAL
CA
01
36910
STATE LICENSE
CA
Enumeration date
08/12/2009
Last updated
08/12/2009
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