| Organization Name: | TAVALLAEI, D.M.D., CORPORATION |
| NPI Number: | 1184780587 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MONICA TAVALLAEI (PEDIATRIC DENTIST) |
| Mailing Address: | 3840 El Dorado Hills Blvd Suite 203 El Dorado Hills |
| State: | CA US |
| Postal Code: | 957624567 |
| Phone Number: | 9169410303 |
| Fax Number: | 9169839012 |
| NPI Enumeration Date: | 12/29/2006 |
| NPI Last Update Date: | 01/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 48036 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |