1629213657 NPI number — YAHYA JABER DENTAL CORP

Table of content: (NPI 1629213657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629213657 NPI number — YAHYA JABER DENTAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAHYA JABER DENTAL CORP
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:
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:
1629213657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12190 PERRIS BLVD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92557-7422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-486-0550
Provider Business Mailing Address Fax Number:
951-486-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12190 PERRIS BLVD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92557-7422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-486-0550
Provider Business Practice Location Address Fax Number:
951-486-0566
Provider Enumeration Date:
12/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JABER
Authorized Official First Name:
YAHYA
Authorized Official Middle Name:
SULIEMAN
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
951-486-0550

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 275395 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 31785 . This is a "SAFEHEALTH LIFE INSURANCE COMPANY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B44184-01 . This is a "DELTA DENTAL HEALTHY FAMILIES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B44189-01 . This is a "DENTICAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2058225 . This is a "BLUE CROSS BLUE SHIELD OF TENNESSEE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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