Provider Demographics
NPI:1336287622
Name:DESAR AND PATEL PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DESAR AND PATEL PROFESSIONAL DENTAL CORPORATION
Other - Org Name:ORANGECREST DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-653-6663
Mailing Address - Street 1:19510 VAN BUREN BLVD
Mailing Address - Street 2:F 5
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9457
Mailing Address - Country:US
Mailing Address - Phone:951-653-6663
Mailing Address - Fax:951-656-5638
Practice Address - Street 1:19510 VAN BUREN BLVD
Practice Address - Street 2:F 5
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-9457
Practice Address - Country:US
Practice Address - Phone:951-653-6663
Practice Address - Fax:951-656-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty