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General NPI Number Information
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NPI Number | 1134376551
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Entity Type | Organization
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Legal Business Name | SOUTHWEST DENTAL GROUP
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 1502 SO LA BRUCHERIE RD.
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 760-482-5505
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Fax | 760-482-5501
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Provider Business Mailing Address
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Address Line | 1502 SO LA BRUCHERIE RD.
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 760-482-5505
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Fax | 760-482-5501
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | MR. JAVAD AGHALOO
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Credential |
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Telephone | 760-482-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37992
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 51184
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License Number State | CA
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