Provider Demographics
NPI:1497131551
Name:S. CHEEMA DENTAL CORPORATION
Entity Type:Organization
Organization Name:S. CHEEMA DENTAL CORPORATION
Other - Org Name:SMILES OF TEMECULA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:951-719-1199
Mailing Address - Street 1:27365 JEFFERSON AVE
Mailing Address - Street 2:SUITE L M
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5692
Mailing Address - Country:US
Mailing Address - Phone:951-719-1199
Mailing Address - Fax:951-719-1128
Practice Address - Street 1:27365 JEFFERSON AVE
Practice Address - Street 2:SUITE L M
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5692
Practice Address - Country:US
Practice Address - Phone:951-719-1199
Practice Address - Fax:951-719-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50578122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467761569Medicaid
CA1598065930Medicaid
CA1700928223Medicaid