Provider Demographics
NPI:1083283121
Name:ALGROUZ DENTAL GROUP
Entity Type:Organization
Organization Name:ALGROUZ DENTAL GROUP
Other - Org Name:RB FAMILY & COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASALA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-473-2308
Mailing Address - Street 1:13350 PACIFIC PL UNIT 2316
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-8230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2558
Practice Address - Country:US
Practice Address - Phone:708-638-6135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental