Provider Demographics
NPI:1679020309
Name:PEARL DENTAL & MEDICAL SERVICES, INC
Entity Type:Organization
Organization Name:PEARL DENTAL & MEDICAL SERVICES, INC
Other - Org Name:DOWNTOWN DENTAL LEMOORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:ABBASI
Authorized Official - Last Name:JAFARINEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-735-4447
Mailing Address - Street 1:5618 W ELOWIN DR
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8917
Mailing Address - Country:US
Mailing Address - Phone:949-735-4447
Mailing Address - Fax:
Practice Address - Street 1:210 HEINLEN ST
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2947
Practice Address - Country:US
Practice Address - Phone:559-924-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58791261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental