| Cypress Dental | |
|
4550 N Lark Ellen Ave Suite # 104 Covina CA 91722-3147 | |
| (626) 331-8041 | |
| (626) 331-4082 |
| Full Name | Cypress Dental |
|---|---|
| Speciality | Clinic/Center |
| Location | 4550 N Lark Ellen Ave, Covina, California |
| Authorized Official Name and Position | Ismail Elsherif (PRESIDENT) |
| Authorized Official Contact | 6263318041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cypress Dental 4550 N Lark Ellen Ave Suite # 104 Covina CA 91722-3147 Ph: (626) 331-8041 | Cypress Dental 4550 N Lark Ellen Ave Suite # 104 Covina CA 91722-3147 Ph: (626) 331-8041 |
| NPI Number | 1790926012 |
|---|---|
| Provider Enumeration Date | 03/17/2009 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 5597993782 |
|---|---|
| Medicare Enrollment ID | O20140129000500 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790926012 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 47883 (California) | Primary |
| Provider Name | Ismail I Elsherif |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1396800173 PECOS PAC ID: 3577791771 Enrollment ID: I20140129000681 |
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