Healthcare Provider Details

I. General information

NPI: 1235945114
Provider Name (Legal Business Name): AMANI DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N PEPPER AVE STE 200
COLTON CA
92324-1839
US

IV. Provider business mailing address

301 N PEPPER AVE STE 200
COLTON CA
92324-1839
US

V. Phone/Fax

Practice location:
  • Phone: 840-336-7600
  • Fax:
Mailing address:
  • Phone: 840-336-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LILA KAKAR
Title or Position: CFO
Credential: DDS
Phone: 516-806-7721