Healthcare Provider Details

I. General information

NPI: 1336067172
Provider Name (Legal Business Name): DANIEL IP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25875 BARTON RD STE 101
LOMA LINDA CA
92354-3892
US

IV. Provider business mailing address

3511 W LA CADENA DR APT 204
RIVERSIDE CA
92501-2281
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4689
  • Fax:
Mailing address:
  • Phone: 626-366-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: