Provider Demographics
NPI:1275757528
Name:DURADENT DENTAL INC.
Entity Type:Organization
Organization Name:DURADENT DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADOSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:PELIKS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-933-7401
Mailing Address - Street 1:1160 SUNCAST LN STE 5
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9327
Mailing Address - Country:US
Mailing Address - Phone:916-933-7401
Mailing Address - Fax:916-933-7413
Practice Address - Street 1:1160 SUNCAST LN STE 5
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9327
Practice Address - Country:US
Practice Address - Phone:916-933-7401
Practice Address - Fax:916-933-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50669261QD0000X
CA53264261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental