Provider Demographics
NPI:1154045870
Name:FIELAT DENTAL CORPORATION
Entity type:Organization
Organization Name:FIELAT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABUL-FIELAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-688-5437
Mailing Address - Street 1:6102 ORBIS WAY STE #520
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880
Mailing Address - Country:US
Mailing Address - Phone:951-688-5437
Mailing Address - Fax:951-848-0904
Practice Address - Street 1:6102 ORBIS WAY STE#520
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3867
Practice Address - Country:US
Practice Address - Phone:951-688-5437
Practice Address - Fax:951-848-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2024-02-16
Deactivation Date:2023-03-28
Deactivation Code:
Reactivation Date:2023-05-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty