Provider Demographics
NPI:1386035459
Name:HOSSEIN A. DENTAL CORPORATION
Entity Type:Organization
Organization Name:HOSSEIN A. DENTAL CORPORATION
Other - Org Name:ACE DENTAL SPECIALTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOLHOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-987-3121
Mailing Address - Street 1:2949 BREA BLVD
Mailing Address - Street 2:A-2
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2073
Mailing Address - Country:US
Mailing Address - Phone:714-987-3121
Mailing Address - Fax:714-987-3120
Practice Address - Street 1:2949 BREA BLVD
Practice Address - Street 2:A-2
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2073
Practice Address - Country:US
Practice Address - Phone:714-987-3121
Practice Address - Fax:714-987-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA507151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty