Healthcare Provider Details

I. General information

NPI: 1669898482
Provider Name (Legal Business Name): CHIRAG DALAL DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 ARLINGTON AVE STE A
RIVERSIDE CA
92503-1518
US

IV. Provider business mailing address

7201 ARLINGTON AVE STE A
RIVERSIDE CA
92503-1518
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50899
License Number StateCA

VIII. Authorized Official

Name: DR. CHIRAG D DALAL
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-536-9960