Provider Demographics
NPI:1205035714
Name:QURESHI DENTAL CORPORATION
Entity Type:Organization
Organization Name:QURESHI DENTAL CORPORATION
Other - Org Name:QURESHI COMPTON FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INCORPORATOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZEEM
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-868-9560
Mailing Address - Street 1:1946 E ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1710
Mailing Address - Country:US
Mailing Address - Phone:310-868-9560
Mailing Address - Fax:310-868-9221
Practice Address - Street 1:1946 E ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1710
Practice Address - Country:US
Practice Address - Phone:310-868-9560
Practice Address - Fax:310-868-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41777261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 94108-01OtherDENTI-CAL/MEDI-CAL