Healthcare Provider Details

I. General information

NPI: 1679491906
Provider Name (Legal Business Name): KWAME AMPONSAH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22471 BARTON RD
GRAND TERRACE CA
92313-5008
US

IV. Provider business mailing address

33732 OLD TRAIL DR
YUCAIPA CA
92399-6974
US

V. Phone/Fax

Practice location:
  • Phone: 909-657-9498
  • Fax:
Mailing address:
  • Phone: 909-810-9594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: