Provider Demographics
NPI:1659439826
Name:CHRISTOPHER Q. VIRAY DENTAL CORP
Entity Type:Organization
Organization Name:CHRISTOPHER Q. VIRAY DENTAL CORP
Other - Org Name:CALAVERAS FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:Q
Authorized Official - Last Name:VIRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-263-0900
Mailing Address - Street 1:79 DEMPSEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035
Mailing Address - Country:US
Mailing Address - Phone:408-263-0900
Mailing Address - Fax:408-263-1070
Practice Address - Street 1:79 DEMPSEY ROAD
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035
Practice Address - Country:US
Practice Address - Phone:408-263-0900
Practice Address - Fax:408-263-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty