Healthcare Provider Details

I. General information

NPI: 1699954594
Provider Name (Legal Business Name): JOSE RUBEN RAMIREZ PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N PALM AVE 103
ONTARIO CA
91762-3215
US

IV. Provider business mailing address

527 N PALM AVE 103
ONTARIO CA
91762-3215
US

V. Phone/Fax

Practice location:
  • Phone: 909-467-2039
  • Fax: 909-467-2052
Mailing address:
  • Phone: 909-467-2039
  • Fax: 909-467-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number55651
License Number StateCA

VIII. Authorized Official

Name: MR. JOSE RUBEN RAMIREZ
Title or Position: DENTAL
Credential: D.D.S
Phone: 909-467-2039