Healthcare Provider Details

I. General information

NPI: 1669048641
Provider Name (Legal Business Name): JULIA BROWN DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 HAVEN AVE STE 12
RANCHO CUCAMONGA CA
91737-6942
US

IV. Provider business mailing address

25745 BARTON RD # 703
LOMA LINDA CA
92354-3812
US

V. Phone/Fax

Practice location:
  • Phone: 909-989-7222
  • Fax: 909-989-7227
Mailing address:
  • Phone: 909-989-7222
  • Fax: 909-989-7227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JULIA EILEEN BROWN
Title or Position: OWNER
Credential: DDS
Phone: 909-659-8799