Healthcare Provider Details

I. General information

NPI: 1346774080
Provider Name (Legal Business Name): MISTINA LOVINA MASSEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6165 VALLEY SPRINGS PKWY STE E
RIVERSIDE CA
92507-0955
US

IV. Provider business mailing address

6165 VALLEY SPRINGS PKWY STE E
RIVERSIDE CA
92507-0955
US

V. Phone/Fax

Practice location:
  • Phone: 951-214-6585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS100760
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number100760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: