Provider Demographics
NPI:1487373486
Name:AHUJA BAYSHORE DENTAL CORP
Entity type:Organization
Organization Name:AHUJA BAYSHORE DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-251-0408
Mailing Address - Street 1:1650 XIMENO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2150
Mailing Address - Country:US
Mailing Address - Phone:562-494-3477
Mailing Address - Fax:
Practice Address - Street 1:1650 XIMENO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2150
Practice Address - Country:US
Practice Address - Phone:562-494-3477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty