Provider Demographics
NPI:1013390483
Name:CHHINA DENTAL GROUP
Entity Type:Organization
Organization Name:CHHINA DENTAL GROUP
Other - Org Name:PINOLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHHINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-721-4457
Mailing Address - Street 1:1310 TARA HILLS DR STE F
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2533
Mailing Address - Country:US
Mailing Address - Phone:510-724-6900
Mailing Address - Fax:510-724-2707
Practice Address - Street 1:1310 TARA HILLS DR STE F
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2533
Practice Address - Country:US
Practice Address - Phone:510-724-6900
Practice Address - Fax:510-724-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3799799261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental