Provider Demographics
NPI:1922580844
Name:N OZDER DDS INC
Entity Type:Organization
Organization Name:N OZDER DDS INC
Other - Org Name:DIAMOND LAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NECDET
Authorized Official - Middle Name:
Authorized Official - Last Name:OZDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-202-0454
Mailing Address - Street 1:1530 E GOLDEN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-3587
Mailing Address - Country:US
Mailing Address - Phone:661-202-0454
Mailing Address - Fax:559-475-0389
Practice Address - Street 1:250 S LYON AVE STE B
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3871
Practice Address - Country:US
Practice Address - Phone:951-658-2354
Practice Address - Fax:951-652-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental