| California Smile Dental Group | |
|
2424 W Ball Rd Suite L Anaheim CA 92804-5272 | |
| (714) 826-9000 | |
| (714) 827-8000 |
| Full Name | California Smile Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 2424 W Ball Rd, Anaheim, California |
| Authorized Official Name and Position | Nizar Alteir (CEO) |
| Authorized Official Contact | 7148269000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| California Smile Dental Group 2424 W Ball Rd Suite L Anaheim CA 92804-5272 Ph: (714) 826-9000 | California Smile Dental Group 2424 W Ball Rd Suite L Anaheim CA 92804-5272 Ph: (714) 826-9000 |
| NPI Number | 1235378860 |
|---|---|
| Provider Enumeration Date | 02/04/2009 |
| Last Update Date | 07/12/2019 |
| Medicare PECOS PAC ID | 3476888017 |
|---|---|
| Medicare Enrollment ID | O20190718000953 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235378860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 41339 (California) | Secondary |
| 1223G0001X | Dentist - General Practice | 39783 (California) | Primary |
| Provider Name | Moutaz Dabbagh |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1174740302 PECOS PAC ID: 6800196874 Enrollment ID: I20190813002814 |
| Provider Name | Nizar Alteir |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1730306952 PECOS PAC ID: 9931400363 Enrollment ID: I20190821001936 |
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