Healthcare Provider Details

I. General information

NPI: 1609657725
Provider Name (Legal Business Name): FIELAT SANDU DENTAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 10/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25523 MARGUERITE PARKWAY UNIT #C
MISSION VIEJO CA
92692-2925
US

IV. Provider business mailing address

25523 MARGUERITE PARKWAY UNIT #C
MISSION VIEJO CA
92692-2925
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-4644
  • Fax: 951-848-0904
Mailing address:
  • Phone: 714-534-4644
  • Fax: 951-848-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD G ABUL-FIELAT
Title or Position: DENTIST/OWNER
Credential:
Phone: 951-688-5437