Provider Demographics
NPI:1275833956
Name:4030 DENTAL INC.
Entity Type:Organization
Organization Name:4030 DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAWAA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDAIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-567-6373
Mailing Address - Street 1:6175 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3915
Mailing Address - Country:US
Mailing Address - Phone:619-583-4030
Mailing Address - Fax:
Practice Address - Street 1:6175 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3915
Practice Address - Country:US
Practice Address - Phone:630-567-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty