| Mgo Dental.com | |
|
654 W 4th St Suite A San Bernardino CA 92410-3216 | |
| (909) 386-3650 | |
| (909) 386-3690 |
| Full Name | Mgo Dental.com |
|---|---|
| Speciality | Dentist |
| Location | 654 W 4th St, San Bernardino, California |
| Authorized Official Name and Position | Manuel Jean Ohannessian (PRESIDENT) |
| Authorized Official Contact | 9093863650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mgo Dental.com Po Box 312 San Bernardino CA 92402-0312 Ph: (909) 386-3650 | Mgo Dental.com 654 W 4th St Suite A San Bernardino CA 92410-3216 Ph: (909) 386-3650 |
| NPI Number | 1841444585 |
|---|---|
| Provider Enumeration Date | 11/07/2008 |
| Last Update Date | 09/25/2014 |
| Medicare PECOS PAC ID | 8426272196 |
|---|---|
| Medicare Enrollment ID | O20141124001869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841444585 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 54182 (California) | Primary |
| Provider Name | Manuel J Ohannessian |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710035910 PECOS PAC ID: 9335363001 Enrollment ID: I20150109002141 |
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