MEDICARE: DR. SAMRA DENTAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1437723152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. SAMRA DENTAL CORP

Provider Business Mailing Address
First Line	:	2143 N TUSTIN ST STE 5
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-3709
Country	:	US
Telephone Number	:	909-379-5060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1667 N MOUNTAIN AVE STE 125
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1781
Country	:	US
Telephone Number	:	909-981-4711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BHUPINDER SAMRA
Credential	:	DMD
Telephone Number	:	909-379-5060

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	05/17/2021

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Directions to “DR. SAMRA DENTAL CORP ” Practice Location

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