Provider Demographics
NPI:1902034432
Name:DEEPAK, RAHIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAHIL
Middle Name:
Last Name:DEEPAK
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 1:4961 MILLBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0773
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12353 MARIPOSA RD
Practice Address - Street 2:SUITE D1
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-6000
Practice Address - Country:US
Practice Address - Phone:760-962-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice