Provider Demographics
NPI:1356471320
Name:PRAKASH KATBAMNA DENTAL CORP.
Entity Type:Organization
Organization Name:PRAKASH KATBAMNA DENTAL CORP.
Other - Org Name:NOBLE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:AMRATLAL
Authorized Official - Last Name:KATBAMNA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-969-1116
Mailing Address - Street 1:590 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2542
Mailing Address - Country:US
Mailing Address - Phone:626-969-1116
Mailing Address - Fax:626-969-0737
Practice Address - Street 1:590 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2542
Practice Address - Country:US
Practice Address - Phone:626-969-1116
Practice Address - Fax:626-969-0737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty