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General NPI Number Information
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NPI Number | 1265692362
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Entity Type | Organization
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Legal Business Name | LOMA LINDA UNIVERSITY SCHOOL OF DENTISTRY
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 24860 TAYLOR ST
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City | LOMA LINDA
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State | CA
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Zip | 92354-2810
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Country | US
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Telephone | 909-558-4613
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Fax | 909-558-4192
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Provider Business Mailing Address
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Address Line | 11092 ANDERSON ST
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City | LOMA LINDA
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State | CA
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Zip | 92350-1706
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Country | US
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Telephone | 909-558-4613
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Fax | 909-558-4192
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Authorized Official
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Title or Position | VICE CHANCELLOR
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Name | MR. VERLON W. STRAUSS
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Credential | CPA, MBA
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Telephone | 909-558-4543
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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 | 2052
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License Number State | CA
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