Provider Demographics
NPI:1689138703
Name:GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER
Entity Type:Organization
Organization Name:GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-221-9333
Mailing Address - Street 1:5140 BUSINESS CENTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5140 BUSINESS CENTER DR STE 120
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1794
Practice Address - Country:US
Practice Address - Phone:707-800-3114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty