Provider Demographics
NPI:1538976204
Name:F.R EDALATPAJOUH DENTAL INC
Entity type:Organization
Organization Name:F.R EDALATPAJOUH DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDALATPAJOUH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-529-7292
Mailing Address - Street 1:10470 FOOTHILL BLVD STE 126
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6945
Mailing Address - Country:US
Mailing Address - Phone:909-989-7888
Mailing Address - Fax:
Practice Address - Street 1:10470 FOOTHILL BLVD STE 126
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6945
Practice Address - Country:US
Practice Address - Phone:909-989-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental