Healthcare Provider Details

I. General information

NPI: 1124840467
Provider Name (Legal Business Name): PATRICIA ANN POMPA, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 N RIVERSIDE AVE
RIALTO CA
92376-8062
US

IV. Provider business mailing address

1723 N RIVERSIDE AVE
RIALTO CA
92376-8062
US

V. Phone/Fax

Practice location:
  • Phone: 909-874-3210
  • Fax: 909-874-3802
Mailing address:
  • Phone: 909-874-3210
  • Fax: 909-874-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StateNULL

VIII. Authorized Official

Name: PATRICIA ANN POMPA
Title or Position: OWNER
Credential: DDS
Phone: 909-874-3210