| Organization Name: | STEVEN GEDULD DDS DENTAL CORPORATION |
| NPI Number: | 1235272246 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELLE L TILUS (OFFICE MANAGER) |
| Mailing Address: | 73660 Civic Center Dr Ste B Twentynine Palms |
| State: | CA US |
| Postal Code: | 922772582 |
| Phone Number: | 7603618056 |
| Fax Number: | 7603618058 |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 032959 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |