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General NPI Number Information
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NPI Number | 1417304841
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Entity Type | Organization
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Legal Business Name | COOLEY RANCH DENTAL GROUP
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 1636 E WASHINGTON ST
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City | COLTON
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State | CA
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Zip | 92324-4605
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Country | US
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Telephone | 909-825-3210
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Fax | 909-884-4697
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Provider Business Mailing Address
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Address Line | 1636 E WASHINGTON ST
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City | COLTON
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State | CA
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Zip | 92324-4605
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Country | US
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Telephone | 909-825-3210
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Fax | 909-884-4697
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | VIAJY B PATEL
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Credential |
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Telephone | 909-825-3210
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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 |
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License Number State |
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