Dr. Susan R Real-Raz, DMD
Dentist, General Practice in Moreno Valley, CA. Individual provider (NPI-1).
NPI number1679624902
StatusActive
Last updated in NPPESFeb 12, 2020
Details
- NPI
- 1679624902
- Entity type
- Individual (NPI-1)
- Name
- Dr. Susan R Real-Raz
- Credential
- DMD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jan 15, 2007
- Certification date
- Feb 12, 2020
- Last updated
- Feb 12, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - DENTIST
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 42402 | CA | Yes |
Practice location
12725 Perris BlvdMoreno Valley, CA 92553-4110
Phone 951-486-0119 · Fax 951-486-9143
Mailing address
12725 Perris BlvdMoreno Valley, CA 92553-4110
Phone 951-486-0119 · Fax 951-486-9143
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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