=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033877261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIKAS SIKKA DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2021
-----------------------------------------------------
Last Update Date | 12/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 W FOOTHILL BLVD STE E
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-3890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-226-6006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 W FOOTHILL BLVD STE E
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91786-3890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | VIKAS SIKKA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 909-226-6006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------