Provider Demographics
NPI:1184806721
Name:DRS.JEEVAN & NEELA GHATNEKAR DDS. INC.
Entity type:Organization
Organization Name:DRS.JEEVAN & NEELA GHATNEKAR DDS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEEVAN
Authorized Official - Middle Name:VINAYAK
Authorized Official - Last Name:GHATNEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-921-9252
Mailing Address - Street 1:8295 E MONTE VISTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1281
Mailing Address - Country:US
Mailing Address - Phone:714-921-9252
Mailing Address - Fax:714-921-9446
Practice Address - Street 1:1402 INDUSTRIAL PARK AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4517
Practice Address - Country:US
Practice Address - Phone:909-798-5777
Practice Address - Fax:909-798-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33425OtherSTATE LIC. NO.
CA39798OtherSTATE LICENSE NO.