Provider Demographics
NPI:1396184727
Name:HARBOR DENTAL ASSOCIATES
Entity type:Organization
Organization Name:HARBOR DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-971-8178
Mailing Address - Street 1:25617 DODGE AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3101
Mailing Address - Country:US
Mailing Address - Phone:310-835-3144
Mailing Address - Fax:310-830-4966
Practice Address - Street 1:25617 DODGE AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3101
Practice Address - Country:US
Practice Address - Phone:310-835-3144
Practice Address - Fax:310-830-4966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAISHALI PATEL DDS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49973302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization