Provider Demographics
NPI:1336285675
Name:GHATNEKAR, NEELA JEEVAN (DDS)
Entity Type:Individual
Prefix:
First Name:NEELA
Middle Name:JEEVAN
Last Name:GHATNEKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 POLO CT
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5536
Mailing Address - Country:US
Mailing Address - Phone:951-789-6020
Mailing Address - Fax:
Practice Address - Street 1:1786 N RIVERSIDE AVE
Practice Address - Street 2:#5
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8059
Practice Address - Country:US
Practice Address - Phone:909-874-0323
Practice Address - Fax:909-874-6585
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice