Provider Demographics
NPI:1699400226
Name:STANDARD BEAN LLC
Entity Type:Organization
Organization Name:STANDARD BEAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANMOL
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHANGU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-839-7413
Mailing Address - Street 1:1350 W ROBINHOOD DR STE 4
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5519
Mailing Address - Country:US
Mailing Address - Phone:209-839-7413
Mailing Address - Fax:
Practice Address - Street 1:1350 W ROBINHOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5519
Practice Address - Country:US
Practice Address - Phone:209-839-7413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental