Provider Demographics
NPI:1720039050
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 1:15209 BEAR VALLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1610
Mailing Address - Country:US
Mailing Address - Phone:760-241-1666
Mailing Address - Fax:760-948-0126
Practice Address - Street 1:15209 BEAR VALLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1610
Practice Address - Country:US
Practice Address - Phone:760-241-1666
Practice Address - Fax:760-948-0126
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 Licenses
StateLicense IDTaxonomies
CA286431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9170805OtherDENTI-CAL