Provider Demographics
NPI:1295861706
Name:SAROJINI K. RAMBHATLA D.D.S., INC.
Entity Type:Organization
Organization Name:SAROJINI K. RAMBHATLA D.D.S., INC.
Other - Org Name:FAIR OAKS FAMILY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAROJINI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAMBHATLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-449-3700
Mailing Address - Street 1:PO BOX 90456
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-0456
Mailing Address - Country:US
Mailing Address - Phone:626-449-3700
Mailing Address - Fax:626-449-8351
Practice Address - Street 1:929 N ORANGE GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3354
Practice Address - Country:US
Practice Address - Phone:626-449-3700
Practice Address - Fax:626-449-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA353181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty