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General NPI Number Information
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NPI Number | 1487130191
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Entity Type | Organization
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Legal Business Name | RASSIWALA DENTAL CORPORATION
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 09/26/2018
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Provider Practice Location Address
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Address Line | 2043 E FREMONT ST STE 8
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City | STOCKTON
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State | CA
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Zip | 95205
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Country | US
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Telephone | 209-466-5000
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Fax | 209-466-4010
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Provider Business Mailing Address
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Address Line | 2043 E FREMONT ST STE 8
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City | STOCKTON
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State | CA
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Zip | 95205-5000
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Country | US
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Telephone | 209-466-5000
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Fax |
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Authorized Official
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Title or Position | DDS/OWNER
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Name | FARHANA RASSIWALA
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Credential |
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Telephone | 925-872-0050
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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 | 54852
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License Number State | CA
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