Provider Demographics
NPI:1235378860
Name:DABBAGH AND AL TEIR DENTAL CORPORATION
Entity Type:Organization
Organization Name:DABBAGH AND AL TEIR DENTAL CORPORATION
Other - Org Name:CALIFORNIA SMILE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTEIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-826-9000
Mailing Address - Street 1:2424 W BALL RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5272
Mailing Address - Country:US
Mailing Address - Phone:714-826-9000
Mailing Address - Fax:714-827-8000
Practice Address - Street 1:2424 W BALL RD
Practice Address - Street 2:SUITE L
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5272
Practice Address - Country:US
Practice Address - Phone:714-826-9000
Practice Address - Fax:714-827-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413391223G0001X
CA397831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty