Healthcare Provider Details

I. General information

NPI: 1760943831
Provider Name (Legal Business Name): ASSURE DENTAL FAMILY CARE & BRACES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 03/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 E WASHINGTON ST STE B
COLTON CA
92324-4185
US

IV. Provider business mailing address

4411 REDONDO BEACH BLVD
LAWNDALE CA
90260-3465
US

V. Phone/Fax

Practice location:
  • Phone: 909-783-9099
  • Fax:
Mailing address:
  • Phone: 310-802-6961
  • Fax: 424-398-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: APRIL WILLIAMS
Title or Position: FINANCE MANAGER
Credential:
Phone: 310-338-0444