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Provider Information for 1982736567

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1982736567

Calendar   Last Updated:  2007-07-08
  Certification Date: 


Name Value
NPI 1982736567
Enumeration Date 2007-03-10
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 29145 AMBERWOOD LN
HIGHLAND, CA 92346-5431
United States

Phone: 909-864-3211 | Fax:
View Map External Link
Primary Practice Address 4160 HIGHLAND AVE STE 6-C
HIGHLAND, CA 92346-2757
United States

Phone: 909-425-2700 | Fax: 909-425-2727
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 42520