Healthcare Provider Details

I. General information

NPI: 1720032287
Provider Name (Legal Business Name): SEGUY & HERNANDEZ, A DENTAL PART.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9560 BASELINE RD SUITE B
ALTA LOMA CA
91701-6435
US

IV. Provider business mailing address

9560 BASELINE RD SUITE B
ALTA LOMA CA
91701-6435
US

V. Phone/Fax

Practice location:
  • Phone: 909-987-7676
  • Fax: 909-948-9413
Mailing address:
  • Phone: 909-987-7676
  • Fax: 909-948-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number26528
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number37836
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number55916
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number46081
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36457
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberFNP 5936
License Number StateCA

VIII. Authorized Official

Name: DR. STEVEN HERNANDEZ
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 909-987-7676