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Organization
SHADI RAD, DDS, A DENTAL CORPORATION
Active
Organization
SHADI RAD, DDS, A DENTAL CORPORATION
Active
Other names
Gateway Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHADI M RAD JADALI DDS, MS (PRESIDENT)
(949) 707-7000
Entity
Organization
Contact information
Practice address
24000 ALICIA PKWY, SUITE 34, MISSION VIEJO, CA 92691-3929
(949) 707-7000
(949) 707-0088
Mailing address
24000 ALICIA PKWY, SUITE 34, MISSION VIEJO, CA 92691-3929
(949) 707-7000
(949) 707-0088
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
51991
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770665291
INDIVIDUAL NPI
CA
Enumeration date
04/22/2014
Last updated
04/22/2014
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