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General NPI Number Information
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NPI Number | 1972160083
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Entity Type | Organization
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Legal Business Name | BANARIA DENTAL GROUP INC
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Dates
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Enumeration Date | 05/23/2019
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 1550 E. AMAR ROAD SUITE V
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City | WEST COVINA
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State | CA
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Zip | 91792
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Country | US
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Telephone | 626-913-3341
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 E. AMAR ROAD SUITE V
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City | WEST COVINA
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State | CA
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Zip | 91792
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Country | US
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Telephone | 626-913-3341
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. VIVIAN CATERIO BANARIA
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Credential | DMD
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Telephone | 626-913-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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