Provider Demographics
NPI:1760928329
Name:PS AHUJA DENTAL CORP
Entity Type:Organization
Organization Name:PS AHUJA DENTAL CORP
Other - Org Name:FULLERSMILES LONG BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSHJOT
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-456-5089
Mailing Address - Street 1:7890 HAVEN AVE STE 3
Mailing Address - Street 2:STE 3
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3072
Mailing Address - Country:US
Mailing Address - Phone:909-484-2505
Mailing Address - Fax:909-484-2507
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:STE 602
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-435-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PS AHUJA DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104088178OtherPERSONAL