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General NPI Number Information
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NPI Number | 1205244837
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Entity Type | Organization
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Legal Business Name | HEMET DENTAL CLINIC
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 940 E MORTON PL
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City | HEMET
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State | CA
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Zip | 92543
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Country | US
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Telephone | 951-652-2796
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Fax | 951-652-2145
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Provider Business Mailing Address
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Address Line | 940 E MORTON PL
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City | HEMET
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State | CA
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Zip | 92543-4529
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Country | US
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Telephone | 951-652-5796
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Fax | 951-652-2145
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Authorized Official
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Title or Position | OWNER/ CEO
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Name | DR. DONALD L IMAN
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Credential | DDS
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Telephone | 951-283-4626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 30538
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License Number State | CA
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