Provider Demographics
NPI:1285640045
Name:ROYAL DENTAL AESTHETICS CORP
Entity type:Organization
Organization Name:ROYAL DENTAL AESTHETICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARAHNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MADANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:714-772-6400
Mailing Address - Street 1:1721 W ROMNEYA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-772-6400
Mailing Address - Fax:714-772-6440
Practice Address - Street 1:1721 W ROMNEYA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-772-6400
Practice Address - Fax:714-772-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty