Healthcare Provider Details

I. General information

NPI: 1659283422
Provider Name (Legal Business Name): PATHAK DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4168 N SIERRA WAY
SAN BERNARDINO CA
92407-3819
US

IV. Provider business mailing address

1142 S DIAMOND BAR BLVD # 624
DIAMOND BAR CA
91765-2203
US

V. Phone/Fax

Practice location:
  • Phone: 909-886-8900
  • Fax:
Mailing address:
  • Phone: 714-310-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROHAN PATHAK
Title or Position: CEO
Credential: DDS
Phone: 714-310-5160