1962626861 NPI number — DR. ODAY ALHALASA DDS,MSD

Table of content: DR. ODAY ALHALASA DDS,MSD (NPI 1962626861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962626861 NPI number — DR. ODAY ALHALASA DDS,MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALHALASA
Provider First Name:
ODAY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS,MSD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALHALASA
Provider Other First Name:
ODAY
Provider Other Middle Name:
HUSAM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS,MSD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962626861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71780 SAN JACINTO DR
Provider Second Line Business Mailing Address:
B3
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-5516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-779-0350
Provider Business Mailing Address Fax Number:
760-779-0348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71780 SAN JACINTO DR
Provider Second Line Business Practice Location Address:
B3
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-5516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-779-0350
Provider Business Practice Location Address Fax Number:
760-779-0348
Provider Enumeration Date:
04/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  50882 , 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)