Provider Demographics
NPI:1669003448
Name:SAMIR RIZVANBEGOVIC,DDS,INC.
Entity Type:Organization
Organization Name:SAMIR RIZVANBEGOVIC,DDS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVANBEGOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-409-2212
Mailing Address - Street 1:44421 TOWN CENTER WAY STE C
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2705
Mailing Address - Country:US
Mailing Address - Phone:760-776-1646
Mailing Address - Fax:760-776-1645
Practice Address - Street 1:44421 TOWN CENTER WAY STE C
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2705
Practice Address - Country:US
Practice Address - Phone:760-776-1646
Practice Address - Fax:760-776-1645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental