| Gateway Dental Group | |
|
24000 Alicia Pkwy Suite 34 Mission Viejo CA 92691-3929 | |
| (949) 707-7000 | |
| (949) 707-0088 |
| Full Name | Gateway Dental Group |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 24000 Alicia Pkwy, Mission Viejo, California |
| Authorized Official Name and Position | Shadi M Rad Jadali (PRESIDENT) |
| Authorized Official Contact | 9497077000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Dental Group 24000 Alicia Pkwy Suite 34 Mission Viejo CA 92691-3929 Ph: (949) 707-7000 | Gateway Dental Group 24000 Alicia Pkwy Suite 34 Mission Viejo CA 92691-3929 Ph: (949) 707-7000 |
| NPI Number | 1932529690 |
|---|---|
| Provider Enumeration Date | 04/22/2014 |
| Last Update Date | 04/22/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932529690 | NPI | - | NPPES |
| 1770665291 | Other | CA | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 51991 (California) | Primary |
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