Provider Demographics
NPI:1083734628
Name:VIKRAM MISHRA,DDS.,DC
Entity Type:Organization
Organization Name:VIKRAM MISHRA,DDS.,DC
Other - Org Name:CHATSWORTH DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-709-1200
Mailing Address - Street 1:21800 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2905
Mailing Address - Country:US
Mailing Address - Phone:818-709-1200
Mailing Address - Fax:
Practice Address - Street 1:21800 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2905
Practice Address - Country:US
Practice Address - Phone:818-709-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty