Provider Demographics
NPI:1578860144
Name:CHOKKA AND SAMBANGI DENTAL CORPORATION
Entity Type:Organization
Organization Name:CHOKKA AND SAMBANGI DENTAL CORPORATION
Other - Org Name:DESERT VALLEY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHAKAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHOKKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-244-2625
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:303-952-0892
Practice Address - Street 1:16868 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6030
Practice Address - Country:US
Practice Address - Phone:760-244-2625
Practice Address - Fax:760-244-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty