1033427315 NPI number — DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033427315 NPI number — DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR.BHAGAT UPPAL & SHAH'S MORNINGSIDE DENTAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DAYCREEK DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033427315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12223 HIGHLAND AVE
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91739-2574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-463-7890
Provider Business Mailing Address Fax Number:
909-463-7367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12223 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
108
Provider Business Practice Location Address City Name:
RANCHO CUCAMONGA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91739-2574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-463-7890
Provider Business Practice Location Address Fax Number:
909-463-7367
Provider Enumeration Date:
09/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KHULLAR
Authorized Official First Name:
REENA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING DENTIST
Authorized Official Telephone Number:
909-463-7890

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  49562 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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