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General NPI Number Information
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NPI Number | 1235092263
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Entity Type | Organization
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Legal Business Name | LITTLE GROVE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 308 W 6TH ST # 203
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City | CORONA
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State | CA
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Zip | 92882-3349
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Country | US
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Telephone | 951-508-0001
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Fax | 951-508-0004
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Provider Business Mailing Address
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Address Line | 308 W 6TH ST # 203
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City | CORONA
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State | CA
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Zip | 92882-3349
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Country | US
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Telephone | 951-508-0001
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Fax | 951-508-0004
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. SUSAN DO
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Credential | DDS
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Telephone | 951-508-0001
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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 |
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License Number State |
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