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General NPI Number Information
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NPI Number | 1114821014
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Entity Type | Organization
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Legal Business Name | LADERA RANCH MODERN DENTISTRY, PROF. CORP
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 27702 CROWN VALLEY PKWY STE A4
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City | LADERA RANCH
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State | CA
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Zip | 92694-0609
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Country | US
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Telephone | 949-354-5268
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Fax | 949-347-5883
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Provider Business Mailing Address
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Address Line | PO BOX 660041
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City | DALLAS
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State | TX
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Zip | 75266-0041
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0892
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Authorized Official
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Title or Position | OWNER
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Name | DEEPIKA DHAMA
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Credential | DDS
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Telephone | 949-354-5268
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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 |
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License Number State | NULL
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