SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC (NPI# 1588715031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588715031 |
| Entity Type | Organization |
| Organization Name | SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC |
| Other Organization Name | SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS |
| Practice Address |
399 E Highland Ave Suite 120 San Bernardino CA 92404-3808 |
| Practice Telephone | 9098810645 |
| Practice Fax Number | 9098814957 |
| Mailing Telephone | 9098810645 |
| Mailing Fax Number | 9098814957 |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ANTOINE O SOURIALLE (OWNER) |
| Authorized Official Telephone | 9098810645 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
44093 | CA | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CIGNA HMO | 210745 | 01 |
| CA | UNITED CONCORDIA HMO | 971330 | 01 |
| CA | WELLPOINT HMO | P006271 | 01 |
| CA | WESTERN DENTAL HMO | 01628 | 01 |
| CA | DHS HMO | 134921 | 01 |
| CA | BLUE SHIELD | 50755-1 | 01 |
| CA | SMILESAVER HMO | DJ61 | 01 |
| CA | GOLDEN WEST HMO | F0275 | 01 |
| CA | MANAGED DENTAL HMO | 0004636 | 01 |
| CA | PMI HMO | 007367 | 01 |
| CA | DELTA HEALTHY FAMILY | B44093-01 | 01 |
| CA | DENTI-CAL | G92830-01 | 01 |
| CA | ASSURANT HMO | 0010973 | 01 |
| CA | LIBERTY DENTAL HMO | 004239 | 01 |
| CA | PACIFICARE HMO | 10490 | 01 |
| CA | PREVIOUS EIN | 20088156 | 01 |
| CA | SAFEGUARD HMO | 97036530 | 01 |
| Other Name | Type Code |
|---|---|
| Southland Dental Group Antoine Sourialle DDS | Former Legal Business Name - Organization |
| Street Address |
399 E HIGHLAND AVE SUITE 120 |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92404-3808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841292935 | William W Goral | Otolaryngology | 399 E Highland Ave, Ste 503, San Bernardino, CA 92404-3873 | 2005-06-02 |
| 1831650563 | Dawn M. Terashita, PC | Preventive Medicine | 399 E Highland Ave, Suite 117, San Bernardino, CA 92404-3808 | 2019-03-26 |
| 1114378171 | Thomas Sin Young Chung | Nurse Practitioner | 399 E Highland Ave, Suite 307, San Bernardino, CA 92404-3808 | 2016-06-30 |
| 1972960714 | Robert Williamsen | Pharmacist | 399 E Highland Ave, Ste 103, San Bernardino, CA 92404-3808 | 2016-01-25 |
| 1649698812 | Victoria Kachaturian | Registered Nurse | 399 E Highland Ave, Suite 324, San Bernardino, CA 92404-3808 | 2014-04-03 |
| 1386061364 | Apex Pediatrics, Inc | Clinical Nurse Specialist | 399 E Highland Ave, Suite 329, San Bernardino, CA 92404-3808 | 2014-03-27 |
| 1205262706 | Nadia M Nemeh | Dietitian, Registered | 399 E Highland Ave, Ste 427, San Bernardino, CA 92404-3808 | 2013-09-17 |
| 1093088064 | Nancy Samudio Md & Philis D Ransom Md, Inc, A Professional Medical Cor | Obstetrics & Gynecology | 399 E Highland Ave, Suite 516, San Bernardino, CA 92404-3808 | 2012-02-21 |
| 1487961421 | Pro Office Inc | General Practice | 399 E Highland Ave, 309, San Bernardino, CA 92404-3808 | 2010-09-13 |
| 1700103561 | Inland Empire Medical Network | Internal Medicine | 399 E Highland Ave, Suite 110, San Bernardino, CA 92404-3808 | 2010-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740849363 | Danniella Alexandra Murillo | Physician Assistant | 2101 North Waterman Ave, San Bernardino, CA 92404 | 2019-06-07 |
| 1902377484 | Shauntel Renee Nelson | Student in an Organized Health Care Education/Training Program | 1481 N. Windsor Dr., San Bernardino, CA 92404 | 2018-12-10 |
| 1487123584 | Garrett M Grigg | Licensed Psychiatric Technician | 1481 N Windsor Dr, San Bernardino, CA 92404 | 2018-11-19 |
| 1881163434 | James Dean Anders | Counselor | 1481 Windsor Drive, San Bernardino, CA 92404 | 2018-11-13 |
| 1043703564 | Samantha Makpaiboonvatana | Optometrist | 1909 N Waterman Ave Ste 3, San Bernardino, CA 92404 | 2018-06-09 |
| 1861981623 | Christopher Windham | Behavior Technician | 2460 Fremontia Dr, San Bernardino, CA 92404 | 2018-05-08 |
| 1891145041 | Cynthia Lusy Gastelum | Marriage & Family Therapist | 1885 E Lynwood Dr Rm Se3, San Bernardino, CA 92404 | 2016-06-20 |
| 1336598259 | Foundation Enterprises LLC | Non-emergency Medical Transport (VAN) | 1663 Date Pl., #30390, San Bernardino, CA 92404 | 2016-06-10 |
| 1881042877 | Helen Ann Thompson | Speech-Language Pathologist | 1311 E. State St., San Bernardo, CA 92404 | 2016-05-31 |
| 1366839938 | Lanecia Richardson | Counselor | 135 Paul Drive, San Rafeal, CA 92404 | 2015-04-22 |
| Find all providers in zip 92404 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124639901 | Arutyun Mkrtchyan D.d.s. Inc | Dentist | 1655 N Mount Vernon Ave Unit B, San Bernardino, CA 92411-1427 | 2020-08-13 |
| 1316555261 | Ryan Andrew Stitzinger | Dentist | 234 N D St, San Bernardino, CA 92401-1702 | 2020-07-16 |
| 1417506932 | Rincon Dds and Associates Inc | Dentist | 1078 E Hospitality Ln, San Bernardino, CA 92408-2878 | 2019-09-06 |
| 1669036117 | Feldkamp Cal Select Dental Group, Inc. | Dentist | 164 W Hospitality Ln Ste 127, San Bernardino, CA 92408-3316 | 2019-04-30 |
| 1609358845 | Arteaga Dental Corporation | Dentist | 494 S Rancho Ave, San Bernardino, CA 92410-2144 | 2018-09-04 |
| 1295213239 | Feldkamp Cal Select Dental Group, Inc. | Dentist | 164 W Hospitality Ln # 107, San Bernardino, CA 92408-3316 | 2018-08-01 |
| 1508370487 | Katy Chou Dds Inc | Dentist | 1799 N Waterman Ave Ste C, San Bernardino, CA 92404-5107 | 2017-11-29 |
| 1700309184 | Eric Williamson | Dentist | 328 Commercial Rd Ste 104, San Bernardino, CA 92408-3766 | 2017-07-18 |
| 1841741360 | Esther Song | Dentist | 2672 S Carl Pl, San Bernardino, CA 92408-4182 | 2016-10-19 |
| 1578916029 | Alexander Reimann | Dentist | 2665 Annapolis Cir, San Bernardino, CA 92408-4133 | 2016-07-20 |
| Find all providers in SAN BERNARDINO | ||||
| City | SAN BERNARDINO |
| Zip Code | 92404 |
Please comment or provide details below to improve the information on SOUTHLAND DENTAL GROUP ANTOINE SOURIALLE DDS INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.