Healthcare Provider Details

I. General information

NPI: 1811036775
Provider Name (Legal Business Name): EMEEL NASHED GHOBRIAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 WEST HOLT BLVD SUITE # C
ONTARIO CA
91762-3710
US

IV. Provider business mailing address

628 WEST HOLT BLVD SUITE # C
ONTARIO CA
91762-3710
US

V. Phone/Fax

Practice location:
  • Phone: 909-986-6424
  • Fax: 909-986-7464
Mailing address:
  • Phone: 909-986-6424
  • Fax: 909-986-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: