Provider Demographics
NPI:1598925000
Name:KATBAMNA, DIPAK A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIPAK
Middle Name:A
Last Name:KATBAMNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 PHELAN RD
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-7675
Mailing Address - Country:US
Mailing Address - Phone:760-868-2244
Mailing Address - Fax:760-868-1542
Practice Address - Street 1:4365 PHELAN RD
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-7675
Practice Address - Country:US
Practice Address - Phone:760-868-2244
Practice Address - Fax:760-868-1542
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist