is a Pediatric Dentistry in San Bernardino, California. practices all healthcare services and medical treatments related to Pediatric Dentistry. The NPI Number for is 1164572053. The last update date is .
's current location address is 1655 N Mount Vernon Ave, San Bernardino, California. You can contact this provider via phone number 9098858707 and fax number 9098859447. The mailing address for is 1655 N Mount Vernon Ave, San Bernardino, California. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1655 N Mount Vernon Ave, San Bernardino, California |
| Phone Number | 9098858707 |
| Fax Number | 9098859447 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1164572053 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1655 N Mount Vernon Ave |
|---|---|
| City | San Bernardino |
| State | California (CA) |
| Post Code | 924111427 |
| Phone Number | 9098858707 |
| Fax Number | 9098859447 |
Provider's Primary Taxonomy Detail
| Speciality | Pediatric Dentistry |
|---|---|
| Taxonomy | 1223P0221X |
| Licence No | 55032 |
|
Definition: An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 161-9568 | CA | UNITED CONCORDIA | |
| G94087-01 | CA | DENTI-CAL |
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