MEDICARE: CHIRAG DALAL DDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50899	CA

General Provider Information

NPI Number	:	1669898482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRAG DALAL DDS, INC

Provider Business Mailing Address
First Line	:	7201 ARLINGTON AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-1518
Country	:	US
Telephone Number	:	951-785-4200
Fax Number	:	951-785-9200

Provider Business Practice Location Address
First Line	:	7201 ARLINGTON AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92503-1518
Country	:	US
Telephone Number	:	951-785-4200
Fax Number	:	951-785-9200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHIRAG D DALAL
Credential	:	DDS
Telephone Number	:	951-536-9960

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	03/18/2014

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