Mohamed Kays Dowaidari DDS PC Delicate Dental Spa Dental Group

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

53592 Issued in CA

Legal business name

MOHAMED KAYS DOWAIDARI DDS PC DELICATE DENTAL SPA DENTAL GROUP

Practice address

1635 N Mountain Ave
Upland, CA 91784-1732

Phone

(909) 982-3300

Fax

(909) 982-3350

NPI assigned

Oct 11, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Natasha L Chatman

Title

Office Manager

Phone

(909) 982-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mohamed Kays DDS PC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537920000000",
    "number": "1508376989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 N MOUNTAIN AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841732",
            "telephone_number": "909-982-3300",
            "fax_number": "909-982-3350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1635 N MOUNTAIN AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841732",
            "telephone_number": "909-982-3300",
            "fax_number": "909-982-3350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHAMED KAYS DOWAIDARI DDS PC DELICATE DENTAL SPA DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-11",
        "last_updated": "2018-09-26",
        "status": "A",
        "authorized_official_last_name": "CHATMAN",
        "authorized_official_first_name": "NATASHA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "909-982-3300"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "53592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01995",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mohamed Kays DDS PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Upland, CA
• Providers in Upland, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.