Healthcare Provider Details

I. General information

NPI: 1528335569
Provider Name (Legal Business Name): ROSS-ARAUJO DENTAL INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 ARLINGTON AVE SUITE R
RIVERSIDE CA
92503-0436
US

IV. Provider business mailing address

8151 ARLINGTON AVE SUITE R
RIVERSIDE CA
92503-0436
US

V. Phone/Fax

Practice location:
  • Phone: 909-730-2758
  • Fax:
Mailing address:
  • Phone: 909-730-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number47036
License Number StateCA

VIII. Authorized Official

Name: JOREG ROMO
Title or Position: ADMINISTRATOR
Credential:
Phone: 909-730-2758