Basic Information
| Provider Information | |||||||||
| NPI: | 1669898482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHIRAG DALAL DDS, INC | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7201 ARLINGTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925031518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517854200 | ||||||||
| FaxNumber: | 9517859200 | ||||||||
| Practice Location | |||||||||
| Address1: | 7201 ARLINGTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925031518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517854200 | ||||||||
| FaxNumber: | 9517859200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2014 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | DALAL | ||||||||
| AuthorizedOfficialFirstName: | CHIRAG | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9515369960 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DDS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 50899 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.