Organization
TAVALLAEI, D.M.D., CORPORATION
Active
Other names
Make a Smile
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MONICA TAVALLAEI D.M.D. (OWNER)
(916) 271-3737
Entity
Organization
Contact information
Practice address
9184 E STOCKTON BLVD STE A, ELK GROVE, CA 95624-9510
(916) 271-3737
Mailing address
2260 E BIDWELL ST # 314, FOLSOM, CA 95630-3555
(916) 271-3737
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/09/2008
Last updated
08/24/2022
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