Healthcare Provider Details

I. General information

NPI: 1336661867
Provider Name (Legal Business Name): MOHAMMAD ABUL FIELAT DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900 PERRIS BLVD STE 201
MORENO VALLEY CA
92553-4135
US

IV. Provider business mailing address

3564 VAN BUREN BLVD
RIVERSIDE CA
92503
US

V. Phone/Fax

Practice location:
  • Phone: 951-243-3120
  • Fax:
Mailing address:
  • Phone: 951-688-5437
  • Fax: 951-688-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number43302
License Number StateCA

VIII. Authorized Official

Name: MOHAMMAD G ABUL-FIELAT
Title or Position: OWNER/DENTIST
Credential:
Phone: 951-818-6017