Provider Demographics
NPI:1255778429
Name:GAD PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:GAD PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:WANLING
Authorized Official - Last Name:GAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-595-8288
Mailing Address - Street 1:20657 GOLDEN SPRINGS DR STE 207
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3875
Mailing Address - Country:US
Mailing Address - Phone:909-595-8288
Mailing Address - Fax:909-595-0188
Practice Address - Street 1:20657 GOLDEN SPRINGS DR STE 207
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-3875
Practice Address - Country:US
Practice Address - Phone:909-595-8288
Practice Address - Fax:909-595-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA383181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty