Provider Demographics
NPI:1639120041
Name:JOSEPH A FOROOSH DENTAL CORP
Entity Type:Organization
Organization Name:JOSEPH A FOROOSH DENTAL CORP
Other - Org Name:DESERT DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOROOSH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-241-3336
Mailing Address - Street 1:12640 HESPERIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7753
Mailing Address - Country:US
Mailing Address - Phone:760-241-3336
Mailing Address - Fax:760-243-7247
Practice Address - Street 1:12640 HESPERIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7753
Practice Address - Country:US
Practice Address - Phone:760-241-3336
Practice Address - Fax:760-243-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91708-01OtherDENTI-CAL
CA62057OtherSAFEGUARD DHMO
CA784059OtherUNITED CONCORDIA
CAD163173OtherCIGNA DHMO