Provider Demographics
NPI:1649512476
Name:PRANAB K. DUTT D.D.S., A.P.C.
Entity type:Organization
Organization Name:PRANAB K. DUTT D.D.S., A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PRANAB
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-352-2773
Mailing Address - Street 1:1540 S IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4241
Mailing Address - Country:US
Mailing Address - Phone:760-352-2773
Mailing Address - Fax:760-352-6711
Practice Address - Street 1:1540 S IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4241
Practice Address - Country:US
Practice Address - Phone:760-352-2773
Practice Address - Fax:760-352-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39788261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental