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General NPI Number Information
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NPI Number | 1730320078
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Entity Type | Organization
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Legal Business Name | PREMAL NAIK DENTAL CORPORATION
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 03/17/2009
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Provider Practice Location Address
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Address Line | 24941 SUNNYMEAD BLVD
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3701
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Country | US
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Telephone | 951-924-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 24941 SUNNYMEAD BLVD
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City | MORENO VALLEY
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State | CA
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Zip | 92553-3701
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Country | US
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Telephone | 951-924-2700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PREMAL KUMAR NAIK MAGANLAL
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Credential |
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Telephone | 951-924-2700
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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 | 55038
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License Number State | CA
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