Provider Demographics
NPI:1023550969
Name:CHIRAG VORA DENTAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CHIRAG VORA DENTAL PROFESSIONAL CORPORATION
Other - Org Name:RENAISSANCE SMILE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:PRAMOD
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-272-0417
Mailing Address - Street 1:2815 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE#105
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-272-0417
Mailing Address - Fax:
Practice Address - Street 1:2815 S MAIN ST
Practice Address - Street 2:SUITE#105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2531
Practice Address - Country:US
Practice Address - Phone:951-272-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty