Provider Demographics
NPI:1003262502
Name:REENA KHULLAR DDS AND PUNEET WADHWA
Entity Type:Organization
Organization Name:REENA KHULLAR DDS AND PUNEET WADHWA
Other - Org Name:ONTARIO KIDS N BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-996-0523
Mailing Address - Street 1:1928 ANO NUEVO DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3055 S ARCHIBALD AVE STE C-1
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-9007
Practice Address - Country:US
Practice Address - Phone:909-466-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X, 1223X0400X
CA49562261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty