Provider Demographics
NPI:1922132109
Name:R & M DENTAL MANAGEMENT CO
Entity Type:Organization
Organization Name:R & M DENTAL MANAGEMENT CO
Other - Org Name:BIG BEAR DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-866-1030
Mailing Address - Street 1:PO BOX 7069
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-7069
Mailing Address - Country:US
Mailing Address - Phone:909-866-1030
Mailing Address - Fax:909-866-1028
Practice Address - Street 1:42169-C BIG BEAR BLVD.
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-866-1030
Practice Address - Fax:909-866-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92354-02Medicaid