Provider Demographics
NPI:1568687754
Name:RODEO DENTAL GROUP
Entity Type:Organization
Organization Name:RODEO DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:831-757-2222
Mailing Address - Street 1:1070 N DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2045
Mailing Address - Country:US
Mailing Address - Phone:831-757-2222
Mailing Address - Fax:
Practice Address - Street 1:1070 N DAVIS RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93907-2045
Practice Address - Country:US
Practice Address - Phone:831-757-2222
Practice Address - Fax:831-424-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty