Provider Demographics
NPI:1730371931
Name:GANATRA DENTAL CORPORATION
Entity type:Organization
Organization Name:GANATRA DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANATRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-665-0005
Mailing Address - Street 1:12791NEWPORT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-665-0005
Mailing Address - Fax:714-665-0055
Practice Address - Street 1:12791NEWPORT AVE
Practice Address - Street 2:200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-665-0005
Practice Address - Fax:714-665-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental