MEDICARE: DR. THERESA M. RAMOS DMD

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	41471	CA

General Provider Information

NPI Number	:	1841250065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA M. RAMOS DMD

Provider Business Mailing Address
First Line	:	1125 EAST 16TH
Second Line	:	SUITE 6
City	:	UPLAND
State	:	CA
Zip	:	91784-9179
Country	:	US
Telephone Number	:	909-946-8441
Fax Number	:	909-946-8291

Provider Business Practice Location Address
First Line	:	1125 EAST 16TH
Second Line	:	SUITE 6
City	:	UPLAND
State	:	CA
Zip	:	91784-9179
Country	:	US
Telephone Number	:	909-946-8441
Fax Number	:	909-946-8291

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/08/2019

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