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General NPI Number Information
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NPI Number | 1205258886
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Entity Type | Organization
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Legal Business Name | CHILDREN DENTAL CARE CENTER
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 2079 COMPTON AVE STE 101B
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City | CORONA
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State | CA
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Zip | 92881-7284
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Country | US
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Telephone | 951-403-6288
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Fax | 626-369-1186
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Provider Business Mailing Address
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Address Line | 2079 COMPTON AVE STE 101B
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City | CORONA
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State | CA
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Zip | 92881-7284
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Country | US
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Telephone | 951-403-6288
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Fax | 626-369-1186
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. JOSEPH CHEN-DER CHIANG
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Credential |
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Telephone | 626-369-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 38660
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License Number State | CA
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