1316150964 NPI number — MOHAMMAD ABUL FIELAT DDS INC

Table of content: (NPI 1316150964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316150964 NPI number — MOHAMMAD ABUL FIELAT DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMAD ABUL FIELAT DDS INC
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:
1316150964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9193 SIERRA AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-355-0385
Provider Business Mailing Address Fax Number:
909-355-0585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16946 MARYGOLD AVE
Provider Second Line Business Practice Location Address:
STE #101
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-355-0385
Provider Business Practice Location Address Fax Number:
909-355-0585
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABUL FIELAT
Authorized Official First Name:
MOHAMAD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-355-0385

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  CA43302 , 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)

  • Identifier: 60543 . This is a "SAFEGUARD" identifier . This identifiers is of the category "OTHER".




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