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General NPI Number Information
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NPI Number | 1427380005
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Entity Type | Organization
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Legal Business Name | PEMA DENTAL CORP
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 782 NORTH BREA BOULEVARD
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City | BREA
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State | CA
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Zip | 92821-3334
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Country | US
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Telephone | 714-257-0330
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Fax | 714-257-0550
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Provider Business Mailing Address
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Address Line | 782 N BREA BLVD
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City | BREA
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State | CA
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Zip | 92821-3334
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Country | US
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Telephone | 714-257-0330
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Fax | 714-257-0550
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Authorized Official
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Title or Position | OWNER
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Name | DR. NILESH PEMA
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Credential | D.D.S
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Telephone | 714-257-0330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 48536
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License Number State | CA
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