Provider Demographics
NPI:1609657725
Name:FIELAT SANDU DENTAL PRACTICE
Entity Type:Organization
Organization Name:FIELAT SANDU DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-688-5437
Mailing Address - Street 1:25523 MARGUERITE PARKWAY
Mailing Address - Street 2:UNIT #C
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2925
Mailing Address - Country:US
Mailing Address - Phone:714-534-4644
Mailing Address - Fax:951-848-0904
Practice Address - Street 1:25523 MARGUERITE PARKWAY
Practice Address - Street 2:UNIT #C
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2925
Practice Address - Country:US
Practice Address - Phone:714-534-4644
Practice Address - Fax:951-848-0904
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIELAT SANDU DENTAL PRACTICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty