Provider Demographics
NPI:1164953873
Name:GREG ARDARY DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:GREG ARDARY DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-290-6964
Mailing Address - Street 1:31821 TEMECULA PKWY STE C-7
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8201
Mailing Address - Country:US
Mailing Address - Phone:951-302-3535
Mailing Address - Fax:
Practice Address - Street 1:31821 TEMECULA PKWY STE C-7
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8201
Practice Address - Country:US
Practice Address - Phone:951-302-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty