Organization
ALIREZA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALIREZA KHANSARI DDS, MSD (PERIODONTIST)
(858) 679-0142
Entity
Organization
Contact information
Practice address
13422 POMERADO RD STE 202, POWAY, CA 92064-3548
(858) 679-0142
(858) 679-0165
Mailing address
PO BOX 1334, POWAY, CA 92074-1334
(858) 679-0142
(858) 679-0165
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
CA
Other
Enumeration date
12/08/2006
Last updated
02/22/2010
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