Provider Demographics
NPI:1063026078
Name:J BHAHEETHARAN DENTAL CORP
Entity Type:Organization
Organization Name:J BHAHEETHARAN DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEYANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAHEETHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:424-757-4149
Mailing Address - Street 1:955 DEEP VALLEY DR UNIT 3417
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3102
Mailing Address - Country:US
Mailing Address - Phone:424-757-4149
Mailing Address - Fax:
Practice Address - Street 1:6131 ORANGETHORPE AVE STE 405
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4902
Practice Address - Country:US
Practice Address - Phone:714-786-6965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty