Provider Demographics
NPI:1891950846
Name:PACIFICA DENTAL
Entity Type:Organization
Organization Name:PACIFICA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHDSAMEER
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AL-JANEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-955-3784
Mailing Address - Street 1:18821 DELAWARE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1935
Mailing Address - Country:US
Mailing Address - Phone:714-848-8211
Mailing Address - Fax:714-848-4570
Practice Address - Street 1:18821 DELAWARE ST
Practice Address - Street 2:STE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1935
Practice Address - Country:US
Practice Address - Phone:714-848-8211
Practice Address - Fax:714-848-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty