Provider Demographics
NPI:1437314317
Name:MOHDSAMEER ALJANEDI PROF DENTAL CORPORATION
Entity Type:Organization
Organization Name:MOHDSAMEER ALJANEDI PROF DENTAL CORPORATION
Other - Org Name:MARINA DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHDSAMEER
Authorized Official - Middle Name:YI
Authorized Official - Last Name:ALJANEDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-386-8188
Mailing Address - Street 1:4292 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5655
Mailing Address - Country:US
Mailing Address - Phone:310-578-5000
Mailing Address - Fax:310-578-5003
Practice Address - Street 1:4292 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5655
Practice Address - Country:US
Practice Address - Phone:310-578-5000
Practice Address - Fax:310-578-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty