MEDICARE: DIMITRI DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1346349685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIMITRI DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	17000 RED HILL AVE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-5626
Country	:	US
Telephone Number	:	714-845-8890
Fax Number	:	303-952-0892

Provider Business Practice Location Address
First Line	:	12571 LIMONITE AVE
Second Line	:	STE. 230
City	:	MIRA LOMA
State	:	CA
Zip	:	91752-3676
Country	:	US
Telephone Number	:	951-360-3444
Fax Number	:	951-360-3484

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAMI DIMITRI
Credential	:	DDS
Telephone Number	:	951-360-3444

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	10/07/2019

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Directions to “DIMITRI DENTAL CORPORATION ” Practice Location

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