Organization
TAVALLAEI, D.M.D., CORPORATION
Active
Other names
Make a Smile
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA TAVALLAEI D.M.D. (OWNER)
(916) 984-0304
Entity
Organization
Contact information
Practice address
2190 E. BIDWELL ST., FOLSOM, CA 95630
(916) 984-0304
(916) 983-9012
Mailing address
2190 E. BIDWELL ST., FOLSOM, CA 95630
(916) 984-0304
(916) 983-9012
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
48036
CA
Other
Enumeration date
12/28/2006
Last updated
08/04/2022
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