Provider Demographics
NPI:1770706731
Name:H HAREESH D.D.S.& VIJAYA PRABHY D.D.S. PTRS H HAREESH DDS GEN. PTR
Entity type:Organization
Organization Name:H HAREESH D.D.S.& VIJAYA PRABHY D.D.S. PTRS H HAREESH DDS GEN. PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAREESH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAREESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-487-2455
Mailing Address - Street 1:480 N STATE ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-6511
Mailing Address - Country:US
Mailing Address - Phone:951-487-2455
Mailing Address - Fax:951-487-2460
Practice Address - Street 1:480 N STATE ST
Practice Address - Street 2:SUITE I
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-6511
Practice Address - Country:US
Practice Address - Phone:951-487-2455
Practice Address - Fax:951-487-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty