Provider Demographics
NPI:1306914494
Name:DHANI, PRITHVI S (DDS)
Entity type:Individual
Prefix:DR
First Name:PRITHVI
Middle Name:S
Last Name:DHANI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26501 RANCHO PKWY S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8301
Mailing Address - Country:US
Mailing Address - Phone:949-297-8600
Mailing Address - Fax:
Practice Address - Street 1:27001 MOULTON PKWY
Practice Address - Street 2:SUITE A206
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92656-3600
Practice Address - Country:US
Practice Address - Phone:949-831-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3702201OtherDENTICAL