Organization
SHALABY PROFESSIONAL DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMER SHALABY DDS (PRESIDENT)
(949) 441-5617
Entity
Organization
Contact information
Practice address
24953 PASEO DE VALENCIA STE 2C, LAGUNA HILLS, CA 92653-4337
(949) 441-5617
Mailing address
24953 PASEO DE VALENCIA STE 2C, LAGUNA HILLS, CA 92653-4337
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DDS55911
DENTIST LICENSE
CA
Enumeration date
07/29/2020
Last updated
01/24/2024
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