Healthcare Provider Details

I. General information

NPI: 1679894992
Provider Name (Legal Business Name): OWJIDENTALCORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 6TH ST
ORANGE COVE CA
93646-2137
US

IV. Provider business mailing address

530 6TH ST
ORANGE COVE CA
93646-2137
US

V. Phone/Fax

Practice location:
  • Phone: 559-626-4547
  • Fax:
Mailing address:
  • Phone: 559-441-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number53844
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMAD-REZA OWJI
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 559-441-3839