Provider Demographics
NPI:1518265800
Name:VIHAR PRAVIN BHAKTA DENTAL CORPORATION
Entity Type:Organization
Organization Name:VIHAR PRAVIN BHAKTA DENTAL CORPORATION
Other - Org Name:OCEAN HEIGHTS DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VIHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-493-0693
Mailing Address - Street 1:5512 E BRITTON DR
Mailing Address - Street 2:SUITE #204
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5512 E BRITTON DR
Practice Address - Street 2:SUITE #204
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3146
Practice Address - Country:US
Practice Address - Phone:562-493-0693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty