Healthcare Provider Details

I. General information

NPI: 1235092263
Provider Name (Legal Business Name): LITTLE GROVE PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W 6TH ST # 203
CORONA CA
92882-3349
US

IV. Provider business mailing address

308 W 6TH ST # 203
CORONA CA
92882-3349
US

V. Phone/Fax

Practice location:
  • Phone: 951-508-0001
  • Fax: 951-508-0004
Mailing address:
  • Phone: 951-508-0001
  • Fax: 951-508-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN DO
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 951-508-0001