Provider Demographics
NPI:1669676185
Name:EHAB ATEIA DDS INC
Entity Type:Organization
Organization Name:EHAB ATEIA DDS INC
Other - Org Name:ALL CARE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ATEIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-466-7966
Mailing Address - Street 1:10399 LEMON AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3770
Mailing Address - Country:US
Mailing Address - Phone:909-466-7966
Mailing Address - Fax:909-466-9519
Practice Address - Street 1:10399 LEMON AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91737-3770
Practice Address - Country:US
Practice Address - Phone:909-466-7966
Practice Address - Fax:909-466-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93357-01Medicaid