Healthcare Provider Details

I. General information

NPI: 1023411204
Provider Name (Legal Business Name): BEGUWALA DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 MAGNOLIA AVE SUITE D
CORONA CA
92879-3109
US

IV. Provider business mailing address

854 MAGNOLIA AVE SUITE D
CORONA CA
92879-3109
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-8884
  • Fax:
Mailing address:
  • Phone: 951-736-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53578
License Number StateCA

VIII. Authorized Official

Name: DR. SUHAIL BEGUWALA
Title or Position: DENTIST
Credential:
Phone: 949-285-9495