Provider Demographics
NPI:1760036305
Name:LLANELL VARARAJ DENTAL INC
Entity Type:Organization
Organization Name:LLANELL VARARAJ DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LLANELL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-599-4176
Mailing Address - Street 1:102 SOUTH WALNUT AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIPPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366
Mailing Address - Country:US
Mailing Address - Phone:209-599-4176
Mailing Address - Fax:209-599-4178
Practice Address - Street 1:102 SOUTH WALNUT AVENUE
Practice Address - Street 2:
Practice Address - City:RIPPON
Practice Address - State:CA
Practice Address - Zip Code:95366
Practice Address - Country:US
Practice Address - Phone:209-599-4176
Practice Address - Fax:209-599-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental