Provider Demographics
NPI:1700292794
Name:BOB DALSANIA DDS PC
Entity Type:Organization
Organization Name:BOB DALSANIA DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:DALSANIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-476-2270
Mailing Address - Street 1:115 S MUNFORD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2527
Mailing Address - Country:US
Mailing Address - Phone:901-476-2270
Mailing Address - Fax:901-476-9943
Practice Address - Street 1:115 S MUNFORD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2527
Practice Address - Country:US
Practice Address - Phone:901-476-2270
Practice Address - Fax:901-476-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS9247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty