Provider Demographics
NPI:1023220506
Name:PERVEEN ALEEMUDDIN DDS, INC.
Entity Type:Organization
Organization Name:PERVEEN ALEEMUDDIN DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEEMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-579-7788
Mailing Address - Street 1:21050 STONYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5012
Mailing Address - Country:US
Mailing Address - Phone:909-595-0873
Mailing Address - Fax:714-579-7780
Practice Address - Street 1:155 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5600
Practice Address - Country:US
Practice Address - Phone:714-579-7788
Practice Address - Fax:714-579-7780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB42516-01OtherDENTI-CAL