Provider Demographics
NPI: | 1508066028 |
---|---|
Name: | R SALWAN DDS INC. |
Entity Type: | Organization |
Organization Name: | R SALWAN DDS INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RANJEEV |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SALWAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 323-581-0754 |
Mailing Address - Street 1: | 8536 LONG BEACH BLVD STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | SOUTH GATE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90280-2017 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-581-0754 |
Mailing Address - Fax: | 323-581-2106 |
Practice Address - Street 1: | 8536 LONG BEACH BLVD STE B |
Practice Address - Street 2: | |
Practice Address - City: | SOUTH GATE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90280-2017 |
Practice Address - Country: | US |
Practice Address - Phone: | 323-581-0754 |
Practice Address - Fax: | 323-581-2106 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-23 |
Last Update Date: | 2014-05-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 33365 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |