Provider Demographics
NPI:1881817328
Name:MOHAMMAD ABUL-FIELAT DDS INC
Entity Type:Organization
Organization Name:MOHAMMAD ABUL-FIELAT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:GHAZI
Authorized Official - Last Name:ABUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-613-1144
Mailing Address - Street 1:14275 PIPELINE AVE.
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5639
Mailing Address - Country:US
Mailing Address - Phone:909-613-1144
Mailing Address - Fax:909-613-0448
Practice Address - Street 1:14275 PIPELINE AVE.
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5639
Practice Address - Country:US
Practice Address - Phone:909-613-1144
Practice Address - Fax:909-613-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4330201Medicaid