Provider Demographics
NPI:1043834468
Name:TEJDEEP S RATTAN DDS INC
Entity Type:Organization
Organization Name:TEJDEEP S RATTAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:RATTAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-369-7843
Mailing Address - Street 1:2955 N CORRAL HOLLOW RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-8800
Mailing Address - Country:US
Mailing Address - Phone:937-369-7843
Mailing Address - Fax:
Practice Address - Street 1:2955 N CORRAL HOLLOW RD STE 100
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-8800
Practice Address - Country:US
Practice Address - Phone:937-369-7843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental