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Organization
SOUTHWEST DENTAL GROUP
Active
Organization
SOUTHWEST DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAVAD AGHALOO (BUSINESS OWNER)
(760) 482-5505
Entity
Organization
Contact information
Practice address
1502 SO LA BRUCHERIE RD., EL CENTRO, CA 92243
(760) 482-5505
(760) 482-5501
Mailing address
1502 SO LA BRUCHERIE RD., EL CENTRO, CA 92243
(760) 482-5505
(760) 482-5501
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
37992
CA
1223G0001X
General Practice Dentistry
Primary
51184
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
719949
UNITED CONCORDIA
—
01
—
B37992-01
HEALTHY FAMILIES
—
Enumeration date
08/27/2008
Last updated
03/29/2010
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