Provider Demographics
NPI:1346349685
Name:DIMITRI DENTAL CORPORATION
Entity Type:Organization
Organization Name:DIMITRI DENTAL CORPORATION
Other - Org Name:GATEWAY DENTAL GROUP AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMITRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-360-3444
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:303-952-0892
Practice Address - Street 1:12571 LIMONITE AVE
Practice Address - Street 2:STE. 230
Practice Address - City:MIRA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91752-3676
Practice Address - Country:US
Practice Address - Phone:951-360-3444
Practice Address - Fax:951-360-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty