Provider Demographics
NPI:1164876462
Name:DIPAK KATBAMNA DDS P.C.
Entity Type:Organization
Organization Name:DIPAK KATBAMNA DDS P.C.
Other - Org Name:MA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KATBAMNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-606-9263
Mailing Address - Street 1:4365 PHELAN RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-7675
Mailing Address - Country:US
Mailing Address - Phone:760-868-2244
Mailing Address - Fax:760-868-1542
Practice Address - Street 1:4365 PHELAN RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-7675
Practice Address - Country:US
Practice Address - Phone:760-868-2244
Practice Address - Fax:760-868-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental