Provider Demographics
NPI:1629780994
Name:S MERCHANT DENTAL CORPORATION
Entity Type:Organization
Organization Name:S MERCHANT DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:AMIT
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-968-3793
Mailing Address - Street 1:949 IRONSHOE CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-0909
Mailing Address - Country:US
Mailing Address - Phone:909-957-8267
Mailing Address - Fax:
Practice Address - Street 1:11201 SIERRA AVE STE 1F
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-7581
Practice Address - Country:US
Practice Address - Phone:909-822-9090
Practice Address - Fax:909-822-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental