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General NPI Number Information
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NPI Number | 1992908800
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Entity Type | Organization
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Legal Business Name | JAMAL DENTAL CORPORATION
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 17250 FOOTHILL BLVD STE E
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City | FONTANA
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State | CA
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Zip | 92335-9052
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Country | US
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Telephone | 909-428-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 17250 FOOTHILL BLVD STE E
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City | FONTANA
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State | CA
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Zip | 92335-9052
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Country | US
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Telephone | 909-428-8500
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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. MANAR JAMAL
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Credential | D.D.S
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Telephone | 909-428-8500
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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 | 43350
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License Number State | CA
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