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General NPI Number Information
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NPI Number | 1073158564
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Entity Type | Organization
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Legal Business Name | NGUYEN TABARI DENTAL INC
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Dates
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Enumeration Date | 11/08/2019
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 10630 TOWN CENTER DR STE 131
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8600
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Country | US
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Telephone | 909-987-8835
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Fax | 909-484-3101
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Provider Business Mailing Address
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Address Line | 10630 TOWN CENTER DR STE 131
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8600
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Country | US
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Telephone | 909-987-8835
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Fax | 909-484-3101
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Authorized Official
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Title or Position | MANAGER
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Name | MYRA WOLFINBARGER
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Credential |
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Telephone | 909-987-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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