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General NPI Number Information
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NPI Number | 1447642152
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Entity Type | Organization
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Legal Business Name | OBAIDI DENTAL CORPORATION
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 657 CAMINO DE LOS MARES SUITE 138
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2826
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Country | US
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Telephone | 949-487-6780
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Fax | 949-487-6781
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Provider Business Mailing Address
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Address Line | 657 CAMINO DE LOS MARES SUITE 138
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2826
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Country | US
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Telephone | 949-487-6780
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Fax | 949-487-6781
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANMAR MAHDI OBAIDI
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Credential | D.D.S.
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Telephone | 949-683-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 56455
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License Number State | CA
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