Healthcare Provider Details

I. General information

NPI: 1255060794
Provider Name (Legal Business Name): THAAR ALDOURI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E FOOTHILL BLVD STE B
POMONA CA
91767-1200
US

IV. Provider business mailing address

3310 COBBLESTONE
LA VERNE CA
91750-3611
US

V. Phone/Fax

Practice location:
  • Phone: 909-624-1781
  • Fax:
Mailing address:
  • Phone: 909-372-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: THAAR ALDOURI
Title or Position: PRESIDENT
Credential:
Phone: 909-372-9676