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General NPI Number Information
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NPI Number | 1154045870
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Entity Type | Organization
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Legal Business Name | FIELAT DENTAL CORPORATION
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 6102 ORBIS WAY STE#520
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City | EASTVALE
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State | CA
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Zip | 92880-3867
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Country | US
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Telephone | 951-688-5437
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Fax | 951-848-0904
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Provider Business Mailing Address
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Address Line | 6102 ORBIS WAY STE #520
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City | EASTVALE
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State | CA
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Zip | 92880
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Country | US
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Telephone | 951-688-5437
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Fax | 951-848-0904
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | MOHAMMAD G ABUL-FIELAT
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Credential |
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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 |
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License Number State |
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