Healthcare Provider Details

I. General information

NPI: 1932220522
Provider Name (Legal Business Name): KRUPAKAR YETURU D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W FRANCIS ST
ONTARIO CA
91762-6525
US

IV. Provider business mailing address

203 W FRANCIS ST
ONTARIO CA
91762-6525
US

V. Phone/Fax

Practice location:
  • Phone: 909-984-2476
  • Fax:
Mailing address:
  • Phone: 909-984-2476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33417
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: