Basic Information
| Provider Information | |||||||||
| NPI: | 1982182523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIRANI | ||||||||
| FirstName: | RHUTVI | ||||||||
| MiddleName: | GANPATRAI | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DENTIST | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7627 SHORELINE DR | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952194591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086804483 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10928 TRINITY PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952197230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094748000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2018 | ||||||||
| LastUpdateDate: | 08/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 103008 | CA | N | Dental Providers | Dentist | General Practice | 122300000X | 103008 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 103008 | 01 | CA | DENTAL BOARD OF CALIFORNIA | OTHER |