Provider Demographics
NPI:1710975172
Name:DALAL, MRUGESH V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MRUGESH
Middle Name:V
Last Name:DALAL
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 1:14544 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2129
Mailing Address - Country:US
Mailing Address - Phone:562-698-9855
Mailing Address - Fax:562-693-3326
Practice Address - Street 1:14544 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2129
Practice Address - Country:US
Practice Address - Phone:562-698-9855
Practice Address - Fax:562-693-3326
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB32288-01Medicaid