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
StateLicense IDTaxonomies
CA46728305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization