Provider Demographics
NPI:1598306490
Name:ELEMENT FAMILY DENTAL
Entity Type:Organization
Organization Name:ELEMENT FAMILY DENTAL
Other - Org Name:ELEMENT DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARANCHAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-672-7417
Mailing Address - Street 1:3860 MYSTIC VALLEY PKWY
Mailing Address - Street 2:UNIT B
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5029
Mailing Address - Country:US
Mailing Address - Phone:617-863-4410
Mailing Address - Fax:617-863-4414
Practice Address - Street 1:3860 MYSTIC VALLEY PKWY
Practice Address - Street 2:UNIT B
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-5029
Practice Address - Country:US
Practice Address - Phone:617-863-4410
Practice Address - Fax:617-863-4414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty