Provider Demographics
NPI:1548976749
Name:DOWLATY DENTAL CORPORATION
Entity type:Organization
Organization Name:DOWLATY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWLATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-253-3172
Mailing Address - Street 1:166 N RAYMOND AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4610
Mailing Address - Country:US
Mailing Address - Phone:714-253-3172
Mailing Address - Fax:
Practice Address - Street 1:166 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4610
Practice Address - Country:US
Practice Address - Phone:714-253-4621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty