Provider Demographics
NPI:1932381266
Name:RK CHETTY DDS INC
Entity Type:Organization
Organization Name:RK CHETTY DDS INC
Other - Org Name:EAGLE ROCK FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-258-2885
Mailing Address - Street 1:2525 COLORADO BLVD
Mailing Address - Street 2:#A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1062
Mailing Address - Country:US
Mailing Address - Phone:323-258-2885
Mailing Address - Fax:323-258-8004
Practice Address - Street 1:2525 COLORADO BLVD
Practice Address - Street 2:#A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1062
Practice Address - Country:US
Practice Address - Phone:323-258-2885
Practice Address - Fax:323-258-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA263601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty