Organization
TAVALLAEI, D.M.D., CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN CASTILLO (MANAGER)
(916) 781-6550
Entity
Organization
Contact information
Practice address
1955 W TEXAS ST STE 2A, FAIRFIELD, CA 94533-4462
(916) 707-7973
Mailing address
2260 E BIDWELL ST # 311, FOLSOM, CA 95630-3555
(916) 781-6550
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
48036
CA
Other
Enumeration date
12/14/2017
Last updated
12/15/2017
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