Provider Demographics
NPI:1437723152
Name:DR. SAMRA DENTAL CORP
Entity Type:Organization
Organization Name:DR. SAMRA DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHUPINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-379-5060
Mailing Address - Street 1:2143 N TUSTIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-3709
Mailing Address - Country:US
Mailing Address - Phone:909-379-5060
Mailing Address - Fax:
Practice Address - Street 1:1667 N MOUNTAIN AVE STE 125
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-1781
Practice Address - Country:US
Practice Address - Phone:909-981-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental