Provider Demographics
NPI:1003440207
Name:MIRA LOMA DENTAL
Entity type:Organization
Organization Name:MIRA LOMA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-737-6005
Mailing Address - Street 1:11058 LIMONITE AVE
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2120
Mailing Address - Country:US
Mailing Address - Phone:951-737-6005
Mailing Address - Fax:951-737-9370
Practice Address - Street 1:11058 LIMONITE AVE
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2120
Practice Address - Country:US
Practice Address - Phone:951-737-6005
Practice Address - Fax:951-737-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty