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General NPI Number Information
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NPI Number | 1720493422
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Entity Type | Organization
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Legal Business Name | A1 DENTAL
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Dates
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Enumeration Date | 06/22/2014
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 12353 MARIPOSA RD SUITE- D1
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City | VICTORVILLE
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State | CA
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Zip | 92395-6000
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Country | US
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Telephone | 760-962-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 12353 MARIPOSA RD STE D1
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City | VICTORVILLE
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State | CA
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Zip | 92395-6015
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Country | US
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Telephone | 760-962-8585
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | DR. RAHIL DEEPAK
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Credential |
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Telephone | 760-962-8585
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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 | 59867
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License Number State | CA
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