Provider Demographics
NPI:1891467940
Name:CHEEMA DENTAL CORP
Entity Type:Organization
Organization Name:CHEEMA DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASBIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHEEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-824-1940
Mailing Address - Street 1:1700 STANDIFORD AVE BLDG 1A
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6534
Mailing Address - Country:US
Mailing Address - Phone:209-916-1700
Mailing Address - Fax:
Practice Address - Street 1:1700 STANDIFORD AVE BLDG 1A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6534
Practice Address - Country:US
Practice Address - Phone:209-916-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHEEMA DENTAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty