| Orangecrest Family Dental Practice | |
|
19348 Van Buren Blvd Ste 117 Riverside CA 92508-9158 | |
| (951) 789-9905 | |
| Not Available |
| Full Name | Orangecrest Family Dental Practice |
|---|---|
| Speciality | Dentist |
| Location | 19348 Van Buren Blvd Ste 117, Riverside, California |
| Authorized Official Name and Position | Sheida Mohammadizadeh (OWNER) |
| Authorized Official Contact | 9517899905 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Orangecrest Family Dental Practice 19348 Van Buren Blvd Ste 117 Riverside CA 92508-9158 Ph: (951) 789-9905 | Orangecrest Family Dental Practice 19348 Van Buren Blvd Ste 117 Riverside CA 92508-9158 Ph: (951) 789-9905 |
| NPI Number | 1124360417 |
|---|---|
| Provider Enumeration Date | 03/25/2013 |
| Last Update Date | 03/25/2013 |
| Medicare PECOS PAC ID | 7719314293 |
|---|---|
| Medicare Enrollment ID | O20200221001587 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124360417 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
| Provider Name | Sheida Mohammadizadeh |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053300574 PECOS PAC ID: 3476980947 Enrollment ID: I20200221001478 |
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