1306111976 NPI number — HENRIOD & MESERKHANI DENTAL PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306111976 NPI number — HENRIOD & MESERKHANI DENTAL PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRIOD & MESERKHANI DENTAL PARTNERSHIP
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:
1306111976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2648 JAMACHA RD
Provider Second Line Business Mailing Address:
SUITE 166
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92019-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-670-5571
Provider Business Mailing Address Fax Number:
619-670-5592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2648 JAMACHA RD
Provider Second Line Business Practice Location Address:
SUITE 166
Provider Business Practice Location Address City Name:
EL CAJON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92019-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-5571
Provider Business Practice Location Address Fax Number:
619-670-5592
Provider Enumeration Date:
03/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HENRIOD
Authorized Official First Name:
JOEL
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER/PARTNERSHIP
Authorized Official Telephone Number:
619-670-5571

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  55124 , 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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