Provider Demographics
NPI:1013615699
Name:PARISA DENTAL GROUP INC
Entity Type:Organization
Organization Name:PARISA DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEIDARPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-254-7032
Mailing Address - Street 1:8599 HAVEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4849
Mailing Address - Country:US
Mailing Address - Phone:909-945-2342
Mailing Address - Fax:909-948-5474
Practice Address - Street 1:8599 HAVEN AVE STE 105
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4849
Practice Address - Country:US
Practice Address - Phone:909-945-2342
Practice Address - Fax:909-948-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty