=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144974015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUCHI ARORA DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2022
-----------------------------------------------------
Last Update Date | 02/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2405 IRON POINT RD STE 100
-----------------------------------------------------
City | FOLSOM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95630-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-5437
-----------------------------------------------------
Fax | 916-885-1392
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 920050
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75392-0050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-983-5437
-----------------------------------------------------
Fax | 916-885-1392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER DENTIST
-----------------------------------------------------
Name | RUCHI ARORA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 916-983-5437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------