Provider Demographics
NPI:1831312248
Name:VIJAYA KV PRABHU. DDS. A PROFFESSIONAL CORP
Entity Type:Organization
Organization Name:VIJAYA KV PRABHU. DDS. A PROFFESSIONAL CORP
Other - Org Name:EL NORTE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:KV
Authorized Official - Last Name:PRABHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-480-5600
Mailing Address - Street 1:306 W EL NORTE PKWY
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-1960
Mailing Address - Country:US
Mailing Address - Phone:760-480-5600
Mailing Address - Fax:760-418-4321
Practice Address - Street 1:306 W EL NORTE PKWY
Practice Address - Street 2:SUITE D & E
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-1960
Practice Address - Country:US
Practice Address - Phone:760-480-5600
Practice Address - Fax:760-418-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1223G0001XOtherDENTIST-GENERAL PRACTICE