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General NPI Number Information
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NPI Number | 1275816753
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Entity Type | Organization
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Legal Business Name | MIGUEL URIBE D.D.S INC D.B.A SANTA CRUZ DENTAL
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 228 W BASE LINE RD
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City | RIALTO
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State | CA
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Zip | 92376-3306
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Country | US
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Telephone | 909-874-7421
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Fax | 909-879-1075
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Provider Business Mailing Address
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Address Line | 228 W BASE LINE RD
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City | RIALTO
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State | CA
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Zip | 92376-3306
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Country | US
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Telephone | 909-874-7421
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Fax | 909-879-1075
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIGUEL URIBE
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Credential | D.D.S
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Telephone | 909-874-7421
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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 | 44113
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License Number State | CA
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