Provider Demographics
NPI:1083031694
Name:BANERJEE DENTAL CORPERATION
Entity Type:Organization
Organization Name:BANERJEE DENTAL CORPERATION
Other - Org Name:CANYON DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-273-0555
Mailing Address - Street 1:2097 COMPTON AVE
Mailing Address - Street 2:BLDG 1, STE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7282
Mailing Address - Country:US
Mailing Address - Phone:951-273-0555
Mailing Address - Fax:
Practice Address - Street 1:2097 COMPTON AVE
Practice Address - Street 2:BLDG 1, STE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-273-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53576261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental