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General NPI Number Information
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NPI Number | 1487792586
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Entity Type | Organization
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Legal Business Name | DESAR PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 6700 INDIANA AVE STE 115
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City | RIVERSIDE
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State | CA
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Zip | 92506-4297
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Country | US
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Telephone | 951-276-2222
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Fax | 951-276-2222
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Provider Business Mailing Address
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Address Line | 6700 INDIANA AVE STE 115
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City | RIVERSIDE
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State | CA
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Zip | 92506-4297
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Country | US
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Telephone | 951-276-2222
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Fax | 951-276-2222
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Authorized Official
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Title or Position | OWNER
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Name | DR. JYOTI V DESAR
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Credential | DDS
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Telephone | 951-276-2222
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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 | 41395
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License Number State | CA
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