1952310039 NPI number — CRYSTAL VALLEY FAMILY DENTISTRY, P.C.

Table of content: AHMED REDA EL HUSSEINY ALI EL SABAGH M.B.B.CH (NPI 1871296921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952310039 NPI number — CRYSTAL VALLEY FAMILY DENTISTRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRYSTAL VALLEY FAMILY DENTISTRY, P.C.
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:
1952310039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1004 SPRING ARBOR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLEBURY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46540-9493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-825-4040
Provider Business Mailing Address Fax Number:
574-825-3377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1004 SPRING ARBOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46540-9493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-825-4040
Provider Business Practice Location Address Fax Number:
574-825-3377
Provider Enumeration Date:
08/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REGAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
574-825-4040

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12010372A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com