Provider Demographics
NPI:1730320078
Name:PREMAL NAIK DENTAL CORPORATION
Entity type:Organization
Organization Name:PREMAL NAIK DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PREMAL KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAIK MAGANLAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-924-2700
Mailing Address - Street 1:24941 SUNNYMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-3701
Mailing Address - Country:US
Mailing Address - Phone:951-924-2700
Mailing Address - Fax:
Practice Address - Street 1:24941 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3701
Practice Address - Country:US
Practice Address - Phone:951-924-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental