BOLSA DENTAL CENTER (NPI# 1972052322) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972052322 |
| Entity Type | Organization |
| Organization Name | BOLSA DENTAL CENTER |
| Other Organization Name | RIVERWALK DENTAL SPA |
| Practice Address |
11695 Slate Ave Ste 200 Riverside CA 92505-5197 |
| Practice Telephone | 9513530050 |
| Practice Fax Number | 9513530060 |
| Mailing Telephone | 9513530050 |
| Mailing Fax Number | 9513530060 |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-09-27 |
| Authorized Official Name | DR. TRUC TRUNG MAI (DENTIST) |
| Authorized Official Telephone | 9513530050 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223G0001X |
Dentist Specialization: General Practice |
44933 | CA | Dental Providers |
| Y | 1223G0001X |
Dentist Specialization: General Practice |
44934 | CA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Riverwalk Dental Spa | Doing Business As Name - Organization |
| Street Address |
11695 SLATE AVE STE 200 |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92505-5197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972952448 | Hieu Trung Mai | Dentist | 11695 Slate Ave Ste 200, Riverside, CA 92505-5197 | 2016-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205458460 | Mark Anthony Vargas | Behavioral Analyst | 94193 Flat Rock Dr Ste 220, Riverside, CA 92505 | 2020-05-11 |
| 1568099976 | Victoria Lee | Student in an Organized Health Care Education/Training Program | Riverside Family Medicine Residency, 10800 Magnolia Avenue, Riverside, CA 92505 | 2020-03-25 |
| 1588222087 | A Homecare Services, Inc | In Home Supportive Care | 4193 Flat Rock Road, Building 200 Suite 206, Riverside, CA 92505 | 2019-05-31 |
| 1609302397 | Tap Pharmacy, Inc. | Pharmacy | 4270 Riverwalk Pkwy Ste 102, Riverside, CA 92505 | 2017-05-02 |
| 1467998658 | Onofre Gascon | Behavior Technician | 11711 Collett Ave, #1614, Riverside, CA 92505 | 2017-01-11 |
| 1780038505 | Nash David Martinez | Emergency Medicine | 10800 Magnolia Ave Dept of Emergency Medicine, Kaiser Permanente Hospital, Riverside, CA 92505 | 2016-04-18 |
| 1447639901 | Jose Joel Manalese Dds Inc | Dentist | 3950 Pierce St., Suite L., Riverside, CA 92505 | 2015-05-29 |
| 1821493230 | Jean Huynh | Physician Assistant | 11725 State Ave., Suite 100, Riverside, CA 92505 | 2014-10-28 |
| 1003160649 | Elaf Farahat | Dietitian, Registered | 10800 Magnolia Avenue., Riverside, CA 92505 | 2012-11-05 |
| 1730458217 | Tammy Lynn Gilmore | Non-emergency Medical Transport (VAN) | 10770 Hole Avenue, 106, Riverside, CA 92505 | 2011-12-29 |
| Find all providers in zip 92505 | ||||
| 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 |
|---|---|---|---|---|
| 1932710522 | Fadi Demian | Dentist | 8990 Garfield St Ste 4, Riverside, CA 92503-3922 | 2020-08-16 |
| 1942819966 | Aaron Michael Coyoca | Dentist | 5051 Canyon Crest Dr Ste 103, Riverside, CA 92507-6035 | 2020-07-26 |
| 1205452265 | Av Family Dentistry | Dentist | 2211 University Ave, Riverside, CA 92507-4259 | 2020-06-24 |
| 1821619966 | Dr Paz Casanova Dental Group Inc | Dentist | 8151 Arlington Ave Ste R, Riverside, CA 92503-0437 | 2020-04-29 |
| 1700439668 | Sumin Kang | Dentist | 19040 Van Buren Blvd Ste 111, Riverside, CA 92508-9160 | 2019-07-19 |
| 1295397107 | Cole Cameron Scott | Dentist | 3731 Tibbetts St Ste 1, Riverside, CA 92506-2604 | 2019-07-01 |
| 1457912040 | Kashif Ahmed | Dentist | 19510 Van Buren Blvd Ste F5, Riverside, CA 92508-9458 | 2019-06-24 |
| 1831652197 | Christina Bui | Dentist | 3602 Riverside Plaza Dr Ste 101, Riverside, CA 92506-2726 | 2019-04-12 |
| 1558846725 | Riverside Family Dental, LLC | Dentist | 1445 Wampanoag Trl Unit 209, Riverside, RI 02915-1019 | 2018-10-03 |
| 1053893271 | Tsibel Dental Practice Inc. | Dentist | 10181 Magnolia Ave, Riverside, CA 92503 | 2018-09-04 |
| Find all providers in RIVERSIDE | ||||
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| 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.