Provider Demographics
NPI:1033721600
Name:KEERATINIJAKAL, TRIGAIN (DMD)
Entity Type:Individual
Prefix:
First Name:TRIGAIN
Middle Name:
Last Name:KEERATINIJAKAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15861 DIANTHUS ST
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8902
Mailing Address - Country:US
Mailing Address - Phone:909-979-4010
Mailing Address - Fax:
Practice Address - Street 1:2471 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1315
Practice Address - Country:US
Practice Address - Phone:530-961-9288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist