Provider Demographics
NPI:1518760057
Name:DIWAN DENTAL INC
Entity type:Organization
Organization Name:DIWAN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:530-662-8115
Mailing Address - Street 1:255 W COURT ST STE D
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2986
Mailing Address - Country:US
Mailing Address - Phone:530-662-8115
Mailing Address - Fax:530-662-1547
Practice Address - Street 1:255 W COURT ST STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2986
Practice Address - Country:US
Practice Address - Phone:530-662-8115
Practice Address - Fax:530-662-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental