Provider Demographics
NPI:1073984944
Name:AXIS DENTAL CARE
Entity Type:Organization
Organization Name:AXIS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRERNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-676-9035
Mailing Address - Street 1:34665 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34665 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4598
Practice Address - Country:US
Practice Address - Phone:510-676-9035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60638261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental