1871084400 NPI number — SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION

Table of content: (NPI 1871084400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871084400 NPI number — SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GLASSELL DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871084400
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
930 S HARVARD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92807-5021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-423-1470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 N GLASSELL ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92866-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-532-5600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DARABI
Authorized Official First Name:
SHEFAGH
Authorized Official Middle Name:
SHERRY
Authorized Official Title or Position:
OWNER DENTIST, CEO
Authorized Official Telephone Number:
714-423-1470

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  59923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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