Organization
TAVALLAEI, D.M.D., CORPORATION
Active
Other names
Make A Smile Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN CASTILLO (OPERATIONS MANAGER)
(916) 781-6550
Entity
Organization
Contact information
Practice address
6406 SUNRISE BLVD STE A, CITRUS HEIGHTS, CA 95610-5992
(916) 306-0333
Mailing address
2260 E BIDWELL ST, FOLSOM, CA 95630-3555
(916) 781-6550
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/13/2018
Last updated
08/05/2022
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