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General NPI Number Information
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NPI Number | 1407224884
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Entity Type | Organization
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Legal Business Name | NOMI SO-LEE DENTAL INC
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Dates
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Enumeration Date | 09/02/2015
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 101 E. REDLANDS BLVD STE 134
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-335-3631
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E. REDLANDS BLVD STE 134
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-335-3631
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NOMI LEE
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Credential |
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Telephone | 909-335-3631
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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 | 55061
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License Number State | CA
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