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General NPI Number Information
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NPI Number | 1063532802
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Entity Type | Organization
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Legal Business Name | MOHAMMAD ABUL FIELAT DDS INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 3564 VAN BUREN BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92503-4214
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Country | US
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Telephone | 951-688-5437
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Fax | 951-688-5434
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Provider Business Mailing Address
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Address Line | 3564 VAN BUREN BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92503
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Country | US
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Telephone | 951-688-5437
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Fax | 951-688-5434
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMAD ABUL FIELAT
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Credential | PEDIATRIC DENTIST
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Telephone | 951-688-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 43302
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License Number State | CA
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