Provider Demographics
NPI:1750438016
Name:MHASKAR, SUPRIYA D (DDS)
Entity type:Individual
Prefix:
First Name:SUPRIYA
Middle Name:D
Last Name:MHASKAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4206
Mailing Address - Country:US
Mailing Address - Phone:909-465-5551
Mailing Address - Fax:909-465-5191
Practice Address - Street 1:5436 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4206
Practice Address - Country:US
Practice Address - Phone:909-465-5551
Practice Address - Fax:909-465-5191
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA514286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist