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General NPI Number Information
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NPI Number | 1891950846
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Entity Type | Organization
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Legal Business Name | PACIFICA DENTAL
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 18821 DELAWARE ST STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1935
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Country | US
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Telephone | 714-848-8211
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Fax | 714-848-4570
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Provider Business Mailing Address
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Address Line | 18821 DELAWARE ST STE 101
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1935
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Country | US
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Telephone | 714-848-8211
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Fax | 714-848-4570
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | DR. MOHDSAMEER Y AL-JANEDI
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Credential | DDS
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Telephone | 714-955-3784
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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 | 41577
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License Number State | CA
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