Provider Demographics
NPI:1336661867
Name:MOHAMMAD ABUL FIELAT DDS INC
Entity Type:Organization
Organization Name:MOHAMMAD ABUL FIELAT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-818-6017
Mailing Address - Street 1:3564 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-688-5437
Mailing Address - Fax:951-688-5434
Practice Address - Street 1:12900 PERRIS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-4135
Practice Address - Country:US
Practice Address - Phone:951-243-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOHAMMAD ABUL FIELAT DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty