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General NPI Number Information
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NPI Number | 1134462823
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Entity Type | Organization
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Legal Business Name | CLAREMONT SERENITY DENTISTRY
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 410 W BASELINE RD
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City | CLAREMONT
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State | CA
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Zip | 91711-1607
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Country | US
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Telephone | 909-398-4800
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Fax | 909-398-4900
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Provider Business Mailing Address
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Address Line | 410 W BASELINE RD
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City | CLAREMONT
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State | CA
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Zip | 91711-1607
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Country | US
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Telephone | 909-398-4800
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Fax | 909-398-4900
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Authorized Official
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Title or Position | DENTIST
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Name | ADRIAN PELAEZ DDS
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Credential | DDS
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Telephone | 909-398-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 57724
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 56002
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License Number State | CA
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