Provider Demographics
NPI:1275036931
Name:MANSOUR DENTAL CORP
Entity Type:Organization
Organization Name:MANSOUR DENTAL CORP
Other - Org Name:AXIOM DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:MALEK
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-201-0144
Mailing Address - Street 1:16 IVANHOE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2034
Mailing Address - Country:US
Mailing Address - Phone:714-222-2261
Mailing Address - Fax:323-489-7718
Practice Address - Street 1:16 IVANHOE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2034
Practice Address - Country:US
Practice Address - Phone:323-489-7717
Practice Address - Fax:323-489-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty