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General NPI Number Information
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NPI Number | 1164294591
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Entity Type | Organization
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Legal Business Name | JORGE DE LA OSA DENTAL CORPORATION
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 03/12/2024
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Provider Practice Location Address
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Address Line | 200 N BRADFORD AVE STE C
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City | PLACENTIA
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State | CA
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Zip | 92870-5646
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Country | US
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Telephone | 909-640-9104
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N BRADFORD AVE STE C
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City | PLACENTIA
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State | CA
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Zip | 92870-5646
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Country | US
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Telephone | 909-640-9104
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PATRICIA GONZALEZ
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Credential |
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Telephone | 909-821-9854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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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 |
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License Number State |
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