Provider Demographics
NPI:1023784469
Name:DAMERJI DENTAL CORPORATION
Entity type:Organization
Organization Name:DAMERJI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMERJI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-562-1826
Mailing Address - Street 1:4620 CONVOY ST STE F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2328
Mailing Address - Country:US
Mailing Address - Phone:858-571-1105
Mailing Address - Fax:858-573-1107
Practice Address - Street 1:4620 CONVOY ST STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-2328
Practice Address - Country:US
Practice Address - Phone:858-571-1105
Practice Address - Fax:858-573-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental