Provider Demographics
NPI:1871084400
Name:SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:SHEFAGH SHERRY DARABI, DDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST, CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEFAGH
Authorized Official - Middle Name:SHERRY
Authorized Official - Last Name:DARABI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-423-1470
Mailing Address - Street 1:930 S HARVARD CIR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-5021
Mailing Address - Country:US
Mailing Address - Phone:714-423-1470
Mailing Address - Fax:
Practice Address - Street 1:245 N GLASSELL ST STE A
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1408
Practice Address - Country:US
Practice Address - Phone:714-532-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59923261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental