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General NPI Number Information
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NPI Number | 1659524726
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Entity Type | Organization
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Legal Business Name | DENTAL CARE OF MONTEBELLO
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Dates
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Enumeration Date | 11/03/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 1332 W WHITTIER BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4601
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Country | US
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Telephone | 818-541-1688
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Fax |
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Provider Business Mailing Address
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Address Line | 3903 ABELLA ST
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City | LA CRESCENTA
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State | CA
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Zip | 91214-2320
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALI JADID
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Credential |
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Telephone | 714-767-5457
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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 | 51111
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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 | 49549
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License Number State | CA
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