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General NPI Number Information
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NPI Number | 1902373640
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Entity Type | Organization
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Legal Business Name | BARSOUM DENTAL
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Dates
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Enumeration Date | 10/31/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 258 E. 9TH STREET
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-920-5222
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Fax | 909-920-5220
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Provider Business Mailing Address
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Address Line | 258 E. 9TH STREET
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City | UPLAND
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State | CA
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Zip | 91786
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Country | US
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Telephone | 909-920-5222
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Fax | 909-920-5220
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Authorized Official
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Title or Position | INSURANCE BILLER
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Name | CASSANDRA L LANDIS
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Credential |
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Telephone | 909-920-5222
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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 |
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License Number State |
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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 |
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License Number State |
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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 |
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License Number State |
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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 |
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License Number State |
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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 |
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License Number State |
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