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General NPI Number Information
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NPI Number | 1730696519
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Entity Type | Organization
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Legal Business Name | BARSOUM DENTAL CORP
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 01/03/2018
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Provider Practice Location Address
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Address Line | 14613 RAMONA AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-902-1708
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Fax | 909-902-1709
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Provider Business Mailing Address
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Address Line | 14613 RAMONA AVE
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-902-1708
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Fax | 909-902-1709
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MAHER LABIB BARSOUM
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Credential | DDS
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Telephone | 909-902-1708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 57231
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 64229
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 64108
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 61000
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 44145
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License Number State | CA
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