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General NPI Number Information
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NPI Number | 1285183194
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Entity Type | Organization
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Legal Business Name | FENNY VIRGIN, DDS, INC.
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 4036 GRAND AVE SUITE D
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City | CHINO
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State | CA
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Zip | 91710-5487
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Country | US
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Telephone | 909-627-9996
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Fax | 909-517-1035
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Provider Business Mailing Address
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Address Line | 4036 GRAND AVE SUITE D
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City | CHINO
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State | CA
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Zip | 91710-5487
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Country | US
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Telephone | 909-627-9996
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Fax | 909-517-1035
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Authorized Official
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Title or Position | PRESIDENT
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Name | FENNY VIRGIN
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Credential | DDS
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Telephone | 909-627-9996
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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 |
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License Number State | CA
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