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General NPI Number Information
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NPI Number | 1043633951
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Entity Type | Organization
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Legal Business Name | AFAR DENTAL INC.
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 01/28/2014
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Provider Practice Location Address
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Address Line | 11233 VALLEY BLVD
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City | EL MONTE
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State | CA
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Zip | 91731-3225
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Country | US
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Telephone | 626-246-1200
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Fax | 626-246-1206
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Provider Business Mailing Address
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Address Line | 11233 VALLEY BLVD
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City | EL MONTE
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State | CA
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Zip | 91731-3225
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Country | US
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Telephone | 626-246-1200
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Fax | 626-246-1206
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CLAUDIA SANTOS
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Credential | B.A.B.S.
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Telephone | 626-246-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 334457
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License Number State | CA
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