Healthcare Provider Details

I. General information

NPI: 1710501846
Provider Name (Legal Business Name): FRANCISCO D FORES DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 TENNESSEE ST STE K1
REDLANDS CA
92373-8152
US

IV. Provider business mailing address

414 TENNESSEE ST STE K1
REDLANDS CA
92373-8152
US

V. Phone/Fax

Practice location:
  • Phone: 661-917-0507
  • Fax:
Mailing address:
  • Phone: 661-917-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JENNY BRAGANZA
Title or Position: CREDENTIALING AND BILLING MANAGER
Credential:
Phone: 562-341-4786