Healthcare Provider Details

I. General information

NPI: 1619592102
Provider Name (Legal Business Name): PDS HOLDINGS I , INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIN ST
ORANGE CA
92868-4525
US

IV. Provider business mailing address

530 S MAIN ST
ORANGE CA
92868-4525
US

V. Phone/Fax

Practice location:
  • Phone: 714-973-2022
  • Fax: 714-571-6445
Mailing address:
  • Phone: 714-973-2022
  • Fax: 714-571-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. PREET TAKKAR
Title or Position: CHIEF INFORMATION OFFICER
Credential:
Phone: 714-571-3372