Provider Demographics
NPI:1417464181
Name:EL DORADO FAMILY DENTAL
Entity Type:Organization
Organization Name:EL DORADO FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:TAISIR
Authorized Official - Last Name:ALBIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, AFAAID
Authorized Official - Phone:310-920-9703
Mailing Address - Street 1:4944 WINDPLAY DR STE 301
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9310
Mailing Address - Country:US
Mailing Address - Phone:530-444-4944
Mailing Address - Fax:530-404-0444
Practice Address - Street 1:4944 WINDPLAY DR STE 301
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9310
Practice Address - Country:US
Practice Address - Phone:530-444-4944
Practice Address - Fax:530-404-0444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBIK DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty