Provider Demographics
NPI:1801806690
Name:DB DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DB DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:646-479-2100
Mailing Address - Street 1:1 RIVER CT
Mailing Address - Street 2:# 3305
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2001
Mailing Address - Country:US
Mailing Address - Phone:646-479-2100
Mailing Address - Fax:
Practice Address - Street 1:1 RIVER CT
Practice Address - Street 2:# 3305
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07310-2001
Practice Address - Country:US
Practice Address - Phone:646-479-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty