Healthcare Provider Details

I. General information

NPI: 1396834800
Provider Name (Legal Business Name): CHIRAG D DALAL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18025 GALE AVE
CITY OF INDUSTRY CA
91748-1245
US

IV. Provider business mailing address

7201 ARLINGTON AVE STE A TROPIC DENTAL OFFICE
RIVERSIDE CA
92503-1518
US

V. Phone/Fax

Practice location:
  • Phone: 626-965-2500
  • Fax:
Mailing address:
  • Phone: 951-785-4200
  • Fax: 951-785-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: