Provider Demographics
NPI:1457543266
Name:KADER, MOHAMMED BAZLUL (D D S)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:BAZLUL
Last Name:KADER
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 PARK VIEW LANE APT#31D
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612
Mailing Address - Country:US
Mailing Address - Phone:909-894-2858
Mailing Address - Fax:
Practice Address - Street 1:1570 W ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-1001
Practice Address - Country:US
Practice Address - Phone:951-662-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56097OtherDENTAL LICENCE