Provider Demographics
NPI:1467576017
Name:ABC DENTAL GROUP,DR'S FAY,MYINT,AUNG A PROF.DENTAL CORP.
Entity Type:Organization
Organization Name:ABC DENTAL GROUP,DR'S FAY,MYINT,AUNG A PROF.DENTAL CORP.
Other - Org Name:ABC DENTAL GROUP-FAGHIH DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-733-9797
Mailing Address - Street 1:2544 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6237
Mailing Address - Country:US
Mailing Address - Phone:559-733-9797
Mailing Address - Fax:559-739-0786
Practice Address - Street 1:2544 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6237
Practice Address - Country:US
Practice Address - Phone:559-733-9797
Practice Address - Fax:559-739-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA185601OtherDELTA CARE USA-HMO
CA159654OtherCIGNA HMO
CA1626OtherCALIFORNIADENTAL NETWORK
CA13674OtherPACIFIC UNION DENTAL HMO
CA761OtherDENTAL NET HMO
CAB40815-01OtherDENTI-CAL
CA349835OtherUNITED CONCORDIA
CAB40815-01OtherHEALTHY FAMILIES