Provider Demographics
NPI:1205244837
Name:HEMET DENTAL CLINIC
Entity type:Organization
Organization Name:HEMET DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:IMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-283-4626
Mailing Address - Street 1:940 E MORTON PL
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4529
Mailing Address - Country:US
Mailing Address - Phone:951-652-5796
Mailing Address - Fax:951-652-2145
Practice Address - Street 1:940 E MORTON PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-652-2796
Practice Address - Fax:951-652-2145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD L IMAN DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30538261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental