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General NPI Number Information
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NPI Number | 1376783845
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Entity Type | Organization
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Legal Business Name | JOSE ENRIQUE AREVALO DDS, INC
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 13161 PEYTON DR SUITE B
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City | CHINO HILLS
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State | CA
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Zip | 91709-6006
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Country | US
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Telephone | 909-465-6861
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Fax | 909-465-6867
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Provider Business Mailing Address
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Address Line | 13161 PEYTON DR SUITE B
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City | CHINO HILLS
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State | CA
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Zip | 91709-6006
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Country | US
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Telephone | 909-465-6861
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Fax | 909-465-6867
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Authorized Official
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Title or Position | PRESIDENT/ DENTIST
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Name | DR. JOSE ENRIQUE AREVALO
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Credential | D.D.S
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Telephone | 909-465-6861
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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 | 49453
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License Number State | CA
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