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Organization
P PUTRASAHAN DDS INC
Active
Organization
P PUTRASAHAN DDS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PERRI SOFIAN PUTRASAHAN DDS (OWNER)
(760) 325-2503
Entity
Organization
Contact information
Practice address
68905 VISTA CHINO, CATHEDRAL CITY, CA 92234-4866
(760) 325-2503
Mailing address
68905 VISTA CHINO, CATHEDRAL CITY, CA 92234-4866
(760) 325-2503
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
39466
CA
Other
Enumeration date
10/01/2007
Last updated
12/26/2013
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