Provider Demographics
NPI:1417465170
Name:HAMED GHORBANIAN, DDS, PROF DENTAL CORP
Entity Type:Organization
Organization Name:HAMED GHORBANIAN, DDS, PROF DENTAL CORP
Other - Org Name:NORCO FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:GHORBANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-372-9094
Mailing Address - Street 1:2031 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3307
Mailing Address - Country:US
Mailing Address - Phone:951-372-9094
Mailing Address - Fax:951-372-9378
Practice Address - Street 1:2031 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-3307
Practice Address - Country:US
Practice Address - Phone:951-372-9094
Practice Address - Fax:951-372-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA389971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty