KHALED EISSA DDS INC - NPI NUMBER 1952745895

Summary

Provider Name: KHALED EISSA DDS INC

NPI Number: 1952745895

Clasification: Dentist (122300000X)

Address:
31737 RIVERSIDE DR STE B
LAKE ELSINORE, CA
ZIP 92530

Phone Number: (951) 674-8707



Detailed Information

KHALED EISSA DDS INC is a dentist in Lake Elsinore, CA. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. The assigned NPI number for this provider is 1952745895 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

31737 RIVERSIDE DR STE B
LAKE ELSINORE, CA
ZIP 92530-890
Phone: (951) 674-8707

The provider's authorized official is Khaled Eissa .
The authorized official title is C.e.o. and has the following contact phone number (763) 587-8345.

The enumeration date for this NPI number is 4/22/2013 and was last updated on 4/22/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 122300000X Dentist 59237 CA Yes

NPI Record

No. Field Name Field Value
1 NPI 1952745895
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name KHALED EISSA DDS INC
5 Provider First Line Business Practice Location Address 31737 RIVERSIDE DR STE B
6 Provider Business Practice Location Address City Name LAKE ELSINORE
7 Provider Business Practice Location Address State Name CA
8 Provider Business Practice Location Address Postal Code 925307890
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 9516748707
11 Provider Enumeration Date 4/22/2013
12 Last Update Date 4/22/2013
13 Authorized Official Last Name EISSA
14 Authorized Official First Name KHALED
15 Authorized Official Title or Position C.E.O.
16 Authorized Official Telephone Number 7635878345
17 Healthcare Provider Taxonomy Code 1 122300000X
18 Provider License Number 1 59237
19 Provider License Number State Code 1 CA
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart N
22 Authorized Official Name Prefix Text DR.
23 Authorized Official Credential Text DDS
24 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.