San Dimas Periodontics | |
1111 W Covina Blvd Ste 220 San Dimas CA 91773-3205 | |
(909) 599-9510 | |
(909) 599-1610 |
Full Name | San Dimas Periodontics |
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Speciality | Dentist - Periodontics |
Location | 1111 W Covina Blvd Ste 220, San Dimas, California |
Authorized Official Name and Position | Mohamed Ihsan Kayali (PRESIDENT) |
Authorized Official Contact | 9095999510 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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San Dimas Periodontics 1111 W Covina Blvd Ste 220 San Dimas CA 91773-3205 Ph: (909) 599-9510 | San Dimas Periodontics 1111 W Covina Blvd Ste 220 San Dimas CA 91773-3205 Ph: (909) 599-9510 |
NPI Number | 1033261391 |
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Provider Enumeration Date | 01/17/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1033261391 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223P0300X | Dentist - Periodontics | 44495 (California) | Primary |
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