Provider Demographics
NPI:1245659192
Name:MOHAMMAD ABUL FILAT DDS INC
Entity type:Organization
Organization Name:MOHAMMAD ABUL FILAT DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-688-5437
Mailing Address - Street 1:1561 E ONTARIO AVE
Mailing Address - Street 2:STE # 103A
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-6662
Mailing Address - Country:US
Mailing Address - Phone:951-688-5437
Mailing Address - Fax:951-688-5434
Practice Address - Street 1:1561 E ONTARIO AVE
Practice Address - Street 2:STE # 103A
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-6662
Practice Address - Country:US
Practice Address - Phone:951-688-5437
Practice Address - Fax:951-688-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9225201Medicaid