Provider Demographics
NPI:1558484527
Name:LAN THAI DINH DDS INC
Entity Type:Organization
Organization Name:LAN THAI DINH DDS INC
Other - Org Name:RIVER ARCH DENTAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:THAI
Authorized Official - Last Name:DINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-923-2273
Mailing Address - Street 1:2920 S ARCHIBALD AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7364
Mailing Address - Country:US
Mailing Address - Phone:909-923-2273
Mailing Address - Fax:909-923-2284
Practice Address - Street 1:2920 S ARCHIBALD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7364
Practice Address - Country:US
Practice Address - Phone:909-923-2273
Practice Address - Fax:909-923-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9373301OtherMEDI-CAL PROVIDER NUMBER
CA1114976347OtherPREVIOUS NPI NUMBER
CA1114976347OtherPREVIOUS NPI NUMBER