1235107079 NPI number — UPLAND DENTAL PRACTICE

Table of content: UMBERTO DE GIROLAMI MD (NPI 1972569127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235107079 NPI number — UPLAND DENTAL PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPLAND DENTAL PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235107079
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 E 7TH ST
Provider Second Line Business Mailing Address:
SUITE 2D
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-6602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-920-6000
Provider Business Mailing Address Fax Number:
909-985-6070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 E 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-6602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-920-6000
Provider Business Practice Location Address Fax Number:
909-985-6070
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EFTEKHARI
Authorized Official First Name:
ABBAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-920-6000

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4991 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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