Healthcare Provider Details

I. General information

NPI: 1356865687
Provider Name (Legal Business Name): RIAD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 260
FOOTHILL RANCH CA
92610-2846
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 260
FOOTHILL RANCH CA
92610-2846
US

V. Phone/Fax

Practice location:
  • Phone: 949-273-8600
  • Fax:
Mailing address:
  • Phone: 949-273-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number100243
License Number StateCA

VIII. Authorized Official

Name: SUZY MIKHAIL
Title or Position: OFFICE MANAGER
Credential:
Phone: 949-273-8600