Provider Demographics
NPI:1558410019
Name:HAREESH DENTAL CORP
Entity type:Organization
Organization Name:HAREESH DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAREESH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEERABHADRAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-487-2455
Mailing Address - Street 1:391 WILKERSON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2254
Mailing Address - Country:US
Mailing Address - Phone:951-943-4007
Mailing Address - Fax:951-943-1037
Practice Address - Street 1:391 WILKERSON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2254
Practice Address - Country:US
Practice Address - Phone:951-943-4007
Practice Address - Fax:951-943-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty