Provider Demographics
NPI:1801003645
Name:PARAG R. KACHALIA, DDS., INC.
Entity type:Organization
Organization Name:PARAG R. KACHALIA, DDS., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARAG
Authorized Official - Middle Name:R
Authorized Official - Last Name:KACHALIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-362-8209
Mailing Address - Street 1:525 BOLLINGER CANYON WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4935
Mailing Address - Country:US
Mailing Address - Phone:925-362-8209
Mailing Address - Fax:925-362-0217
Practice Address - Street 1:525 BOLLINGER CANYON WAY STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-4935
Practice Address - Country:US
Practice Address - Phone:925-362-8209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty