Provider Demographics
NPI:1063511459
Name:PORE, DHANESH R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DHANESH
Middle Name:R
Last Name:PORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29910 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:SUITE R
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3814
Mailing Address - Country:US
Mailing Address - Phone:951-677-9104
Mailing Address - Fax:951-677-9206
Practice Address - Street 1:29910 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE R
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3814
Practice Address - Country:US
Practice Address - Phone:951-677-9104
Practice Address - Fax:951-677-9206
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice