Provider Demographics
NPI:1912420340
Name:MOULIK D.D.S. INC
Entity Type:Organization
Organization Name:MOULIK D.D.S. INC
Other - Org Name:SANTA ANA MAGIC SMILE DENTAL PRACTICE OF MOULIK D.D.S INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHASWATI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-292-5863
Mailing Address - Street 1:2112 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2738
Mailing Address - Country:US
Mailing Address - Phone:714-835-6677
Mailing Address - Fax:
Practice Address - Street 1:2112 N MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2738
Practice Address - Country:US
Practice Address - Phone:714-835-6677
Practice Address - Fax:714-558-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty