Healthcare Provider Details

I. General information

NPI: 1356359236
Provider Name (Legal Business Name): MANUEL G. FIGUEROA D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S MOUNTAIN AVE
ONTARIO CA
91762
US

IV. Provider business mailing address

802 S MOUNTAIN AVE
ONTARIO CA
91762
US

V. Phone/Fax

Practice location:
  • Phone: 805-533-3524
  • Fax: 905-933-3527
Mailing address:
  • Phone: 805-533-3524
  • Fax: 905-933-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38185
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38185
License Number StateCA

VIII. Authorized Official

Name: MANUEL G FIGUEROA
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 905-953-3524