MEDICARE: UNIVERSAL DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	40993	CA

General Provider Information

NPI Number	:	1740486521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL DENTAL GROUP

Provider Business Mailing Address
First Line	:	667 INDIAN HILL BLVD
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5303
Country	:	US
Telephone Number	:	909-620-6664
Fax Number	:

Provider Business Practice Location Address
First Line	:	667 INDIAN HILL BLVD
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5303
Country	:	US
Telephone Number	:	909-620-6664
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HA NHI TRAN
Credential	:	D.D.S.
Telephone Number	:	909-620-6664

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	09/26/2007

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Directions to “UNIVERSAL DENTAL GROUP ” Practice Location

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