Healthcare Provider Details

I. General information

NPI: 1629363494
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF CHINO HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 GRAND AVE STE 265
CHINO HILLS CA
91709-6806
US

IV. Provider business mailing address

2140 GRAND AVE STE 265
CHINO HILLS CA
91709-6806
US

V. Phone/Fax

Practice location:
  • Phone: 909-464-2811
  • Fax: 909-464-8484
Mailing address:
  • Phone: 909-464-2811
  • Fax: 909-464-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYANT I BHATT
Title or Position: OWNER
Credential: DDS
Phone: 909-464-2811