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Organization
KSL DENTAL GROUP INC
Active
Organization
KSL DENTAL GROUP INC
Active
Other names
Fresh Leaf Dental
Organization subpart
No
Provider details
NPI number
Authorized official
NEVEIN AMER DDS (PRESIDENT/OWNER)
(972) 746-0881
Entity
Organization
Contact information
Practice address
815 W HOLT BLVD STE 402, ONTARIO, CA 91762-3681
(972) 746-0881
Mailing address
815 W HOLT BLVD STE 402, ONTARIO, CA 91762-3681
(972) 746-0881
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
47881
CA
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47881
DDS
CA
Enumeration date
07/07/2015
Last updated
12/06/2022
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