Organization
SAN DIMAS PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED IHSAN KAYALI D.D.S. (PRESIDENT)
(909) 599-9510
Entity
Organization
Contact information
Practice address
1111 W COVINA BLVD STE 220, SAN DIMAS, CA 91773-3205
(909) 599-9510
(909) 599-1610
Mailing address
1111 W COVINA BLVD STE 220, SAN DIMAS, CA 91773-3205
(909) 599-9510
(909) 599-1610
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
44495
CA
Other
Enumeration date
01/17/2007
Last updated
08/22/2020
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