OrganizationSharifian Dental Corporation(Tustin Dental Office)DentistDental ProvidersPractice Address13721 Newport Ave, Ste. 1, Tustin, CA 92780-4690(714) 368-1400(714) 508-3600PECOS EnrollmentBased on the most recent information from CMS, provider Sharifian Dental Corporation does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1144313339Provider TypeOrganizationFull NameSharifian Dental CorporationOther NameTustin Dental OfficeSubpartNoEnumeration Date10/2/2006Last Updated8/22/2020Contact InformationPractice LocationPractice Address13721 Newport Ave, Ste. 1, Tustin, CA 92780-4690Phone(714) 368-1400Fax(714) 368-1411Mailing LocationMailing Address2860 Michelle, 2nd Floor, Irvine, CA 92606-1009Phone(714) 508-3600Fax(714) 368-2092Authorized OfficialNameSharifian, Alex R (Owner Dds)Phone(714) 368-1400Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XDescriptionDentistDental ProvidersLicense44540CaliforniaCode1223P0300XDescriptionDentistDental ProvidersLicense43860CaliforniaCode1223S0112XDescriptionDentistDental ProvidersLicenseOMS19CaliforniaCode1223X0400XDescriptionDentistDental ProvidersLicense46427California