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General NPI Number Information
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NPI Number | 1407273030
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Entity Type | Organization
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Legal Business Name | CORNERSTONE DENTAL CARE INC
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Dates
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Enumeration Date | 03/20/2014
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 2836 W RIALTO AVE # A
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City | RIALTO
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State | CA
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Zip | 92376-6816
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Country | US
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Telephone | 909-820-9454
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Fax | 909-820-9482
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Provider Business Mailing Address
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Address Line | 2836 W RIALTO AVE # A
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City | RIALTO
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State | CA
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Zip | 92376-6816
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Country | US
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Telephone | 909-820-9454
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Fax | 909-820-9482
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HENRY SANG KWON
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Credential | D.D.S.
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Telephone | 909-820-9454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47505
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License Number State | CA
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