Provider Demographics
NPI:1962811349
Name:DONALD L IMAN DDS INC.
Entity type:Organization
Organization Name:DONALD L IMAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:IMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-283-4626
Mailing Address - Street 1:23470 OLIVE WOOD PLAZA DR STE 170
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5267
Mailing Address - Country:US
Mailing Address - Phone:951-242-8426
Mailing Address - Fax:951-242-5639
Practice Address - Street 1:23470 OLIVE WOOD PLAZA DR STE 170
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5267
Practice Address - Country:US
Practice Address - Phone:951-242-8426
Practice Address - Fax:951-242-5639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DONALD L IMAN DDS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30538261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental