Provider Demographics
NPI:1790589133
Name:SATVATABDOL DDS APC
Entity type:Organization
Organization Name:SATVATABDOL DDS APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEISSIER
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALS
Authorized Official - Phone:909-606-4500
Mailing Address - Street 1:14050 CHERRY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92337-8312
Mailing Address - Country:US
Mailing Address - Phone:909-280-4742
Mailing Address - Fax:909-280-4742
Practice Address - Street 1:14050 CHERRY AVE
Practice Address - Street 2:UNIT A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92337-8312
Practice Address - Country:US
Practice Address - Phone:909-280-4742
Practice Address - Fax:909-280-4742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty