Provider Demographics
NPI:1518687888
Name:GARDEN GROVE MEDICAL AND DENTAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:GARDEN GROVE MEDICAL AND DENTAL SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-818-6017
Mailing Address - Street 1:12828 HARBOR BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5834
Mailing Address - Country:US
Mailing Address - Phone:714-844-9212
Mailing Address - Fax:714-844-9212
Practice Address - Street 1:12828 HARBOR BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5834
Practice Address - Country:US
Practice Address - Phone:714-844-9212
Practice Address - Fax:714-844-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical