Provider Demographics
NPI:1083807671
Name:NEIL VADECHA DMD INC
Entity Type:Organization
Organization Name:NEIL VADECHA DMD INC
Other - Org Name:CLAREMONT ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:VIDEN
Authorized Official - Last Name:VADECHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-625-1234
Mailing Address - Street 1:540 W BASELINE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1612
Mailing Address - Country:US
Mailing Address - Phone:909-625-1234
Mailing Address - Fax:909-625-4500
Practice Address - Street 1:540 W BASELINE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-1612
Practice Address - Country:US
Practice Address - Phone:909-625-1234
Practice Address - Fax:909-625-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty