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General NPI Number Information
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NPI Number | 1194051292
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Entity Type | Organization
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Legal Business Name | LOURDES CARDOSO DDS INC.
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 1051 N MOUNTAIN AVE
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City | ONTARIO
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State | CA
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Zip | 91762-2157
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Country | US
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Telephone | 909-988-1800
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Fax | 909-988-1833
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Provider Business Mailing Address
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Address Line | 1051 N. MOUNTAIN AVE.
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City | ONTARIO
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State | CA
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Zip | 91762
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Country | US
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Telephone | 909-988-1800
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Fax | 909-988-1833
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOURDES CARDOSO
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Credential | DDS
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Telephone | 909-988-1800
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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 | 50895
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License Number State | CA
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