| Blu Oasis Dental | |
|
79845 Highway 111 Suite 101 La Quinta CA 92253-4758 | |
| (760) 342-2258 | |
| (760) 342-6258 |
| Full Name | Blu Oasis Dental |
|---|---|
| Speciality | Dentist |
| Location | 79845 Highway 111, La Quinta, California |
| Authorized Official Name and Position | Nash Sourial (OWNER) |
| Authorized Official Contact | 7603422258 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blu Oasis Dental 79845 Highway 111 Suite 101 La Quinta CA 92253-4758 Ph: (760) 342-2258 | Blu Oasis Dental 79845 Highway 111 Suite 101 La Quinta CA 92253-4758 Ph: (760) 342-2258 |
| NPI Number | 1609202746 |
|---|---|
| Provider Enumeration Date | 09/20/2013 |
| Last Update Date | 09/20/2013 |
| Medicare PECOS PAC ID | 0244646974 |
|---|---|
| Medicare Enrollment ID | O20210304000996 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609202746 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| Provider Name | Nash Sourial |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1699931394 PECOS PAC ID: 4486975984 Enrollment ID: I20210304001166 |
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