Provider Demographics
NPI:1003015082
Name:PRAVINCHANDRA MAKADIA DDS
Entity Type:Organization
Organization Name:PRAVINCHANDRA MAKADIA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAKADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,
Authorized Official - Phone:909-622-1817
Mailing Address - Street 1:826 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-2044
Mailing Address - Country:US
Mailing Address - Phone:909-622-1817
Mailing Address - Fax:909-622-8750
Practice Address - Street 1:826 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2044
Practice Address - Country:US
Practice Address - Phone:909-622-1817
Practice Address - Fax:909-622-8750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty