Provider Demographics
NPI:1689913105
Name:BANERJEE DENTAL CORP
Entity Type:Organization
Organization Name:BANERJEE DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-273-0555
Mailing Address - Street 1:2097 COMPTON AVE
Mailing Address - Street 2:BLDG1 STE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881
Mailing Address - Country:US
Mailing Address - Phone:951-273-0555
Mailing Address - Fax:951-273-1555
Practice Address - Street 1:2097 COMPTON AVE
Practice Address - Street 2:BLDG1 STE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-273-0555
Practice Address - Fax:951-273-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty