KSL DENTAL GROUP INC NPI 1033592241

NPI Information

  • NPI: 1033592241
  • Provider Name: KSL DENTAL GROUP INC
  • Classification: Dentist - 122300000X
  • Entity Type: Organization
  • Doing Business As: FRESH LEAF DENTAL
  • Address: 815 W HOLT BLVD STE 402
    ONTARIO, CA
    ZIP 91762
  • Phone: (972) 746-0881

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NPI Details

KSL DENTAL GROUP INC is a dentist in Ontario, 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. KSL DENTAL GROUP INC NPI is 1033592241. The provider is registered as an organization entity type.
The provider Is Doing Business As Fresh Leaf Dental.

The provider's business location address is:

815 W HOLT BLVD STE 402
ONTARIO, CA
ZIP 91762-681
Phone: (972) 746-0881

The provider's authorized official is Nevein Amer .
The authorized official title is President/owner and has the following contact phone number (972) 746-0881.

The enumeration date for this NPI number is 7/7/2015 and was last updated on 12/6/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. 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
1261QD0000XClinic/CenterDentalNo
2122300000XDentist47881CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
147881OTHERCALIFORNIADDS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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