Provider Demographics
NPI:1477124493
Name:OZDER GHORBANIAN A DENTAL CORPORATION
Entity type:Organization
Organization Name:OZDER GHORBANIAN A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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 1:30521 SHELTER CANYON RD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-3042
Mailing Address - Country:US
Mailing Address - Phone:661-202-0454
Mailing Address - Fax:
Practice Address - Street 1:2015 N WATERMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4810
Practice Address - Country:US
Practice Address - Phone:909-980-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty