Provider Demographics
NPI:1366001422
Name:SIERRA GATEWAY DENTAL OFFICE
Entity Type:Organization
Organization Name:SIERRA GATEWAY DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-477-1349
Mailing Address - Street 1:4168 N SIERRA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-3819
Mailing Address - Country:US
Mailing Address - Phone:909-886-8900
Mailing Address - Fax:909-886-9991
Practice Address - Street 1:4168 N SIERRA WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-3819
Practice Address - Country:US
Practice Address - Phone:909-886-8900
Practice Address - Fax:909-886-9991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty