Provider Demographics
NPI:1578622304
Name:PARIKH, SUJAL HEMANTKUMAR
Entity Type:Individual
Prefix:
First Name:SUJAL
Middle Name:HEMANTKUMAR
Last Name:PARIKH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11948 STEGMEIR DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2507
Mailing Address - Country:US
Mailing Address - Phone:909-645-7059
Mailing Address - Fax:
Practice Address - Street 1:15290 BEAR VALLEY RD STE B
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8515
Practice Address - Country:US
Practice Address - Phone:760-951-7777
Practice Address - Fax:760-951-1582
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist