Provider Demographics
NPI:1326357245
Name:DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP
Entity Type:Organization
Organization Name:DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP
Other - Org Name:MORNINGSIDE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-822-7374
Mailing Address - Street 1:14584 BASELINE AVE
Mailing Address - Street 2:340
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1646
Mailing Address - Country:US
Mailing Address - Phone:909-822-7374
Mailing Address - Fax:909-822-7350
Practice Address - Street 1:14584 BASELINE AVE
Practice Address - Street 2:340
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1646
Practice Address - Country:US
Practice Address - Phone:909-822-7374
Practice Address - Fax:909-822-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty