Healthcare Provider Details

I. General information

NPI: 1881717957
Provider Name (Legal Business Name): SUNEAL NAIK DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W RAMSEY ST SUITE B-2
BANNING CA
92220-4400
US

IV. Provider business mailing address

1035 W RAMSEY ST SUITE B-2
BANNING CA
92220-4400
US

V. Phone/Fax

Practice location:
  • Phone: 951-922-2322
  • Fax: 951-922-2319
Mailing address:
  • Phone: 951-922-2322
  • Fax: 951-922-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number36217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD36217
License Number StateCA

VIII. Authorized Official

Name: DR. SUNEAL P NAIK
Title or Position: DENTIST/CEO
Credential: DDS
Phone: 951-789-7123