Provider Demographics
NPI:1336203074
Name:CHERAG DINSHAW SARKARI DDS A DENTAL CORPORATION
Entity type:Organization
Organization Name:CHERAG DINSHAW SARKARI DDS A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERAG
Authorized Official - Middle Name:D
Authorized Official - Last Name:SARKARI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-563-6011
Mailing Address - Street 1:8890 CAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACARMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:916-922-5000
Mailing Address - Fax:916-646-9000
Practice Address - Street 1:902 E HAMMER LANE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210
Practice Address - Country:US
Practice Address - Phone:209-957-9500
Practice Address - Fax:209-957-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94147-13Medicaid