Healthcare Provider Details

I. General information

NPI: 1003428822
Provider Name (Legal Business Name): GOEL, COHEN & RIAZI DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 HIGHWAY 76
FALLBROOK CA
92028-9318
US

IV. Provider business mailing address

3108 HIGHWAY 76
FALLBROOK CA
92028-9318
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-1193
  • Fax:
Mailing address:
  • Phone: 760-723-1193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN COHEN
Title or Position: PRESIDENT
Credential:
Phone: 310-749-8013