Healthcare Provider Details

I. General information

NPI: 1114133824
Provider Name (Legal Business Name): ROBERT MARI G RAMOS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 NORTH GRAND AVE
WALNUT CA
91789
US

IV. Provider business mailing address

1249 NORTH GRAND AVE
WALNUT CA
91789
US

V. Phone/Fax

Practice location:
  • Phone: 909-444-9488
  • Fax: 909-444-9788
Mailing address:
  • Phone: 909-444-9488
  • Fax: 909-444-9788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number49397
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT MARI GUERRERO RAMOS
Title or Position: PRESIDENT
Credential: DDS
Phone: 909-444-9488