NPIMap

Organization Active NPI

Atef R Rezkalla DDS Inc

Doing business as Long Beach Dental

  • General Practice Dentistry
  • Long Beach, CA
National Provider Identifier
1689888711
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
48004 Issued in CA
Legal business name
ATEF R REZKALLA DDS INC
Doing business as
Long Beach Dental
Practice address
308 Orange Ave
Long Beach, CA 90802-3536
Phone
(562) 436-4214
NPI assigned
May 9, 2007
Last updated
Feb 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

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

Authorized official

Name
Dr. Atef R. Rezkalla, DDSNPI 1578631800
Title
Owner
Phone
(562) 436-4214

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 48004 CA Primary

Addresses

Primary practice location

308 Orange Ave
Long Beach, CA 90802-3536

Mailing address

308 Orange Ave
Long Beach, CA 90802-3536
Phone (562) 436-4214

Other identifiers 1

IdentifierTypeStateIssuer
G89823MedicaidCA

Other names 1

  • Long Beach Dental Doing business as

National Provider Directory

National Provider Directory

Locations

308 Orange Ave
Long Beach, CA 90802
Phone (562) 436-4214

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1689888711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 ORANGE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908023536",
            "telephone_number": "562-436-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 ORANGE AVE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908023536",
            "telephone_number": "562-436-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATEF R REZKALLA DDS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "REZKALLA",
        "authorized_official_first_name": "ATEF",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "562-436-4214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "48004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G89823",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Long Beach Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2008; 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.