Provider Demographics
NPI:1487130191
Name:RASSIWALA DENTAL CORPORATION
Entity type:Organization
Organization Name:RASSIWALA DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RASSIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-872-0050
Mailing Address - Street 1:2043 E FREMONT ST STE 8
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-5000
Mailing Address - Country:US
Mailing Address - Phone:209-466-5000
Mailing Address - Fax:
Practice Address - Street 1:2043 E FREMONT ST STE 8
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205
Practice Address - Country:US
Practice Address - Phone:209-466-5000
Practice Address - Fax:209-466-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty