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General NPI Number Information
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NPI Number | 1316351794
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Entity Type | Organization
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Legal Business Name | SUPRIYA D MHASKAR A DENTAL CORP
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 5436 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-465-5551
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Fax | 909-465-5191
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Provider Business Mailing Address
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Address Line | 5436 RIVERSIDE DR
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City | CHINO
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State | CA
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Zip | 91710-4206
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Country | US
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Telephone | 909-465-5551
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Fax | 909-465-5191
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUPRIYA DHANANJAYA MHASKAR
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Credential | DDS
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Telephone | 909-465-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40278
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License Number State | CA
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