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General NPI Number Information
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NPI Number | 1629780994
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Entity Type | Organization
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Legal Business Name | S MERCHANT DENTAL CORPORATION
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 11201 SIERRA AVE STE 1F
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City | FONTANA
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State | CA
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Zip | 92337-7581
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Country | US
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Telephone | 909-822-9090
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Fax | 909-822-9094
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Provider Business Mailing Address
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Address Line | 949 IRONSHOE CT
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City | WALNUT
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State | CA
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Zip | 91789-0909
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Country | US
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Telephone | 909-957-8267
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANJAY AMIT MERCHANT
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Credential | DDS
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Telephone | 626-968-3793
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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 |
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License Number State |
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