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General NPI Number Information
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NPI Number | 1679865778
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Entity Type | Organization
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Legal Business Name | DR. SAMUEL'S DENTAL GROUP, INC.
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Dates
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Enumeration Date | 05/06/2011
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Last Update Date | 05/06/2011
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Provider Practice Location Address
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Address Line | 6860 BROCKTON AVE STE 10
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City | RIVERSIDE
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State | CA
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Zip | 92506-3816
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Country | US
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Telephone | 951-683-5225
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Fax |
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Provider Business Mailing Address
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Address Line | 71949 HIGHWAY 111 STE 100
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4826
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Country | US
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Telephone | 909-844-6866
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAVEEN SAMUEL
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Credential | D.D.S.
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Telephone | 909-844-6866
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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 | 51299
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License Number State | CA
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