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General NPI Number Information
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NPI Number | 1033427315
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Entity Type | Organization
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Legal Business Name | DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 12223 HIGHLAND AVE 108
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2574
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Country | US
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Telephone | 909-463-7890
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Fax | 909-463-7367
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Provider Business Mailing Address
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Address Line | 12223 HIGHLAND AVE 108
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2574
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Country | US
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Telephone | 909-463-7890
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Fax | 909-463-7367
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Authorized Official
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Title or Position | MANAGING DENTIST
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Name | DR. REENA KHULLAR
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Credential | D.D.S
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Telephone | 909-463-7890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49562
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License Number State | CA
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