San Dimas Periodontics

NPI #1033261391 in San Dimas, California

Provider Information

NPI Number: 1033261391
Entity Type: Organization
Organization Name: San Dimas Periodontics
Primary Specialty: Dentist - Periodontics
Enumeration Date: Jan 17, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 1111 W COVINA BLVD STE 220
City: San Dimas
State: California
ZIP Code: 91773-3205
Phone: (909) 599-9510

Authorized Official

Name: DR. MOHAMED IHSAN KAYALI, D.D.S.
Title: PRESIDENT
Phone: (909) 599-9510

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Periodontics — Periodontics	1223P0300X	Primary

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