Provider Demographics
NPI:1487792586
Name:DESAR PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:DESAR PROFESSIONAL DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-276-2222
Mailing Address - Street 1:6700 INDIANA AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4297
Mailing Address - Country:US
Mailing Address - Phone:951-276-2222
Mailing Address - Fax:951-276-2222
Practice Address - Street 1:6700 INDIANA AVE STE 115
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4297
Practice Address - Country:US
Practice Address - Phone:951-276-2222
Practice Address - Fax:951-276-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty