Provider Demographics
NPI:1063532802
Name:MOHAMMAD ABUL FIELAT DDS INC
Entity type:Organization
Organization Name:MOHAMMAD ABUL FIELAT DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUL FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:PEDIATRIC DENTIST
Authorized Official - Phone:951-688-5437
Mailing Address - Street 1:3564 VAN BUREN BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-688-5437
Mailing Address - Fax:951-688-5434
Practice Address - Street 1:3564 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4214
Practice Address - Country:US
Practice Address - Phone:951-688-5437
Practice Address - Fax:951-688-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9225201Medicaid