Provider Demographics
NPI:1801034517
Name:FOREVER SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS
Entity Type:Organization
Organization Name:FOREVER SMILES PEDIATRIC DENTISTRY AND ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OSSAMA
Authorized Official - Middle Name:MURAD
Authorized Official - Last Name:SAFAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-896-0509
Mailing Address - Street 1:641 W ROUTE 66
Mailing Address - Street 2:#E
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4149
Mailing Address - Country:US
Mailing Address - Phone:909-896-0509
Mailing Address - Fax:
Practice Address - Street 1:641 W ROUTE 66
Practice Address - Street 2:#E
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4149
Practice Address - Country:US
Practice Address - Phone:909-896-0509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty