Provider Demographics
NPI:1134296429
Name:DESERT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DESERT FAMILY DENTISTRY
Other - Org Name:DESERT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOLNAR
Authorized Official - Middle Name:SEDGHI
Authorized Official - Last Name:BERENJI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-337-8868
Mailing Address - Street 1:1501 OCOTILLO DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243
Mailing Address - Country:US
Mailing Address - Phone:760-337-8868
Mailing Address - Fax:760-337-8898
Practice Address - Street 1:1501 OCOTILLO DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:760-337-8868
Practice Address - Fax:760-337-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40776122300000X
CA44256122300000X
CA25517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty