=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255215448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESHAD DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27871 MEDICAL CENTER RD STE 260
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-2850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27871 MEDICAL CENTER RD STE 260
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-6406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-364-2850
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOHAMMAD RESHAD
-----------------------------------------------------
Credential | DDS.MS
-----------------------------------------------------
Telephone | 949-364-2850
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------