Provider Demographics
NPI:1063847390
Name:INFINITY DENTAL CARE
Entity Type:Organization
Organization Name:INFINITY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARATI
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-523-6505
Mailing Address - Street 1:5325 W BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5325 W BASELINE RD
Practice Address - Street 2:5325
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-6447
Practice Address - Country:US
Practice Address - Phone:503-523-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD91181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty