Provider Demographics
NPI: | 1164778585 |
---|---|
Name: | SAMIR ALASWAD DENTAL CORP |
Entity Type: | Organization |
Organization Name: | SAMIR ALASWAD DENTAL CORP |
Other - Org Name: | ORANGEVALE DENTAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SAMIR |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALASWAD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 916-988-5559 |
Mailing Address - Street 1: | 8851 GREENBACK LN |
Mailing Address - Street 2: | |
Mailing Address - City: | ORANGEVALE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95662-4058 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-988-5559 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8851 GREENBACK LANE |
Practice Address - Street 2: | |
Practice Address - City: | ORANGEVALE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95662-4058 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-988-5559 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-08-03 |
Last Update Date: | 2012-08-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 46728 | 305R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 305R00000X | Managed Care Organizations | Preferred Provider Organization |