Basic Information
| Provider Information | |||||||||
| NPI: | 1669965604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BRINDHA SUBRAMANIAN, BDS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23082 RIDGE ROUTE DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498372766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23082 RIDGE ROUTE DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498372766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | FEHMER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5625775641 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 58339 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 58339 | 01 | CA | DENTAL BOARD OF CALIFORNIA | OTHER |