Provider Demographics
NPI:1407080104
Name:PRABHJOT SINGH AHUJA
Entity Type:Organization
Organization Name:PRABHJOT SINGH AHUJA
Other - Org Name:AHUJA DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SAUCEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DENTAL ASSISTANT
Authorized Official - Phone:909-231-8248
Mailing Address - Street 1:1130 N. RIVERSIDE AVE.
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376
Mailing Address - Country:US
Mailing Address - Phone:951-660-2751
Mailing Address - Fax:909-873-0288
Practice Address - Street 1:1130 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4342
Practice Address - Country:US
Practice Address - Phone:951-660-2751
Practice Address - Fax:909-873-0288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRABHJOT SINGH AHUJA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty